Hands and feet play crucial roles in everyday activities, so when a health condition affects the nails it can significantly disrupt daily routines. From pitting and ridges to discoloration and crumbling, nail psoriasis can manifest in various ways, affecting not only the health of your nails but also your self-confidence.

Nail psoriasis is less talked about than other types of autoimmune conditions, but it's estimated that 80% to 90% of people living with psoriasis will experience nail psoriasis at some point in their lives. (Source)

Understanding the causes and triggers of nail psoriasis can help you manage symptoms effectively so you feel better faster. In this article, we will explore the common triggers of nail psoriasis, available treatment options, and discuss natural remedies that may offer relief. 

What Is Nail Psoriasis?

Nail psoriasis is an autoimmune condition associated with psoriasis, a skin disorder characterized by patchy, scaly lesions. It occurs due to excessive cell production in the nails, resulting in changes such as thickening, discoloration, or other nail irregularities. (Source)

Having psoriasis is a significant risk factor for developing nail psoriasis. Around 50% of people diagnosed with psoriasis are affected by nail psoriasis at any given time. People with psoriatic arthritis, a type of psoriasis that affects the joints, are also much more likely to be affected by nail psoriasis. Family history and increasing age are additional risk factors. 

Nail psoriasis can often disrupt daily activities and lead to feelings of embarrassment or self-consciousness due to the appearance of nails, leading to a higher prevalence of anxiety and depression. (Source)

What Are the Symptoms of Nail Psoriasis?

Nail psoriasis symptoms range in severity and include: 

• nail thickening
• nail pitting that looks like small pinpoint depressions or dents
• color changes under the nail, including turning yellow, red, or pink
• thin or crumbling nails
• deep horizontal indentations across the nail (called Beau lines)
• nail separates from the skin (onycholysis)
• splinter hemorrhages that look like thin red or brown lines running along the nail
• build-up of skin cells under the nail plate (called subungual hyperkeratosis)

(Source)

What Causes Nail Psoriasis?

The exact cause of psoriasis remains unknown, but it’s believed to be caused by a combination of genetic, environmental, and immune system factors. (Source)

As mentioned above, nail psoriasis is an autoimmune condition. Research suggests that an upregulated inflammatory response is at least partly a cause of psoriasis and nail psoriasis. (Source)

Since most people with nail psoriasis also have psoriasis, triggers include many of the factors associated with autoimmunity, including:

• physical or psychological stress
• lack of sleep
• hormone changes
• injury or trauma to the nail
• environmental toxins
• viral or bacterial infections

(Source, Source)

How Is Nail Psoriasis Diagnosed?

Nail psoriasis is usually diagnosed by a dermatologist after a physical examination. If you already live with psoriasis, your health care provider might be able to diagnose nail psoriasis just by looking at your nails, along with other presenting symptoms such as joint pain or skin lesions. Your health care provider will also rule out anything else that could cause nail changes, such as fungal infection, nutrient deficiencies, or other inflammatory conditions. Nail psoriasis is sometimes confused with nail fungus, but the two are very different, and nail psoriasis is not contagious. 

Sometimes, nail biopsies may be used to gather information that can help with challenging diagnoses. However, these biopsies are not commonly performed as they are invasive and can cause bleeding, pain, more nail problems, and an increased risk of infection. 

Several types of scales are used to determine the severity of nail psoriasis. For example, one of the most commonly used in research is the nail psoriasis severity index (NAPSI). NAPSI uses a numerical scale from 0 to 80 to assess the severity of nail psoriasis, where a higher score means greater severity. (Source, Source)

Does Nail Psoriasis Ever Go Away?

There's no cure for nail psoriasis, but it can be managed to minimize symptoms and keep it from interfering with your daily life. Symptoms can completely disappear (known as remission), but sometimes, they may return (known as a relapse). 

Following your management plan, including lifestyle changes such as improving sleep, reducing stress, and making healthy dietary choices, can significantly help with symptoms and reduce the chance of a relapse. Additionally, regular check-ins with your health care provider can help monitor the progression of nail psoriasis and catch any changes as early as possible.

What Are Treatments for Nail Psoriasis?

A personalized approach is the best way to treat nail psoriasis, as every person may respond differently or have varying degrees of severity. Medication is often the first consideration, but lifestyle choices can also create a foundation of support to address inflammation and calm the immune system long-term.

Understanding your treatment options can help you make the right choice for your body. 

Topical Treatments

Topical treatments are usually the first-line treatment of nail psoriasis for mild cases. Steroids may be used to suppress the immune system to slow down the rapid reproduction of skin cells. Synthetic forms of topical vitamin A and vitamin D may also be applied to the skin to help slow down cell production. (Source)

Long-term use of topical steroids may cause damage to the nail and surrounding areas, and topical drugs don’t always effectively reach the deeper layers of the nail, so sometimes these options don’t work for severe cases. (Source)

Injections

Corticosteroids or methotrexate can be injected into the nail bed to reduce inflammation and decrease cell turnover. While they can be effective, some studies suggest injections are less likely to be used because of pain and side effects. (Source)

Systemic Medications

Systemic therapies such as biologics may be prescribed if nail psoriasis is severe or accompanied by other types of psoriasis. This includes oral or injected medications that target inflammation throughout the body by lowering the immune response. Because of their associated risks, these are often only considered in severe cases that don’t respond to other treatments. (Source)

Phototherapy

Exposure to certain types of ultraviolet rays can help reduce the effects of nail psoriasis. This is often done with other treatments, such as topical medications or injections. (Source)

Natural Remedies for Nail Psoriasis

Living with an autoimmune condition means finding what works for you, and it can take time to put the puzzle pieces together. Lifestyle habits such as managing stress, getting better sleep, and utilizing natural remedies can be essential parts of the journey, sometimes in combination with medications, and other times on their own.

You can learn more details about how lifestyle changes with WellTheory’s Ultimate Guide to Lifestyle Changes for Autoimmune Health, but here are some natural remedies to consider for nail psoriasis:

Nail Care

Any injury or irritants to the nail matrix (the area of the nail that produces new cells) can worsen psoriasis symptoms, so it’s essential to take care when washing and grooming nails. Wash with mild soap and moisturize hands liberally, especially after drying activities such as washing dishes. (Source)

Ideally, nails should be fairly short (avoid artificial nails that can tear the nail bed), and try to avoid biting your nails or cuticles. You can also use gloves to protect your hands from irritants. (Source)

Nutrition

Nutrition plays an essential role in any autoimmune condition, and nail psoriasis is no different. Dietary strategies can help identify foods that may worsen symptoms or trigger flare-ups. The autoimmune protocol (AIP) is one diet used to support inflammation and identify problematic foods. While no studies examine AIP specifically for nail psoriasis, research has found it helps other autoimmune conditions. (Source)

Anti-inflammatory diets, which focus on nutrient-rich foods such as fruits, vegetables, and healthy fats like olive oil, avocado, and nuts, may also reduce inflammation. While there’s no specific research on nutrition and nail psoriasis, studies suggest that an anti-inflammatory diet may help reduce inflammation that contributes to autoimmune disease. (Source)

Turmeric 

Curcumin, a compound found in turmeric, is known for its anti-inflammatory properties. It works by inhibiting various inflammatory pathways in the body and enhancing the production of anti-inflammatory molecules. Some research has shown that taking curcumin supplements may help reduce inflammation in psoriasis. (Source)

Aloe Vera

Aloe vera may help reduce inflammation and soothe irritated skin when applied topically. Studies have been done primarily on skin and have shown that aloe vera extract helped with symptoms of psoriasis without any side effects. (Source)

Omega-3 Fatty Acids

Omega-3 fatty acids, found in supplements and in foods such as fatty fish and flax seeds, may inhibit the production of pro-inflammatory molecules and promote the production of anti-inflammatory compounds. By modulating the immune response and suppressing inflammatory processes, omega-3 fatty acids may help alleviate the redness, itching, and scaling associated with psoriasis and nail psoriasis. (Source)

The Bottom Line

Nail psoriasis is commonly associated with other forms of psoriasis and causes inflammation, redness, and scaling around the nails. You can reduce or eliminate symptoms with a management approach that’s personalized to your body.

Medications can help, but lifestyle changes and home remedies may also be effective, especially if you are looking for options without side effects. The WellTheory membership can provide a personalized plan to help you effectively manage nail psoriasis. Membership gives you access to a care team who can provide accountability and expert support for symptom relief and long-term health.