Psoriatic Nails? Don’t Despair: Help Is Available

If you’re dealing with psoriatic nails, you can find relief. Here are some promising treatment options.

Fifteen years ago, I went to a dermatologist to get my pinky toes checked out. Those little guys were thickening and yellowing, and I was concerned I might have toenail fungus.

“Those are classic psoriatic nails,” the doctor said nonchalantly.

When I asked for more information, she told me there was no effective treatment: I should keep them filed and short. This was a decade before I was diagnosed with PsA, and I hadn’t experienced any skin plaques, so I was surprised to hear the word “psoriasis.”

Didn’t psoriasis mean red, scaling skin?

“Psoriatic symptoms present themselves in various ways,” she said. She left the examination room without offering much more information, so I figured there was nothing I could do.

Looking back, I wish I would have asked for more guidance. Psoriatic nails often appear years before other PsA symptoms, and since so many people who have psoriatic nails develop PsA, referring me to a rheumatologist back then might have saved me a lot of worry and discomfort later in life.

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My journey with psoriatic nails

I’ve developed many more PsA symptoms, including pain and swelling in my hands and feet. All of my toenails are psoriatic now. They’re raised, pitted, cracked, misshapen, and sometimes tender.

I always liked my feet — now, I don’t recognize them.

Luckily, my fingernails don’t seem to be affected, though I’m careful about wearing gloves when I do the dishes, because exposure to water for long periods of time can exacerbate psoriatic nail symptoms.

Many credible online sources offer detailed descriptions of various treatment options. And since that first visit to the dermatologist, I’ve found a lot of over-the-counter (OTC) as well as prescription treatment options. Some have minimized my symptoms and offered me hope.

If you’re also dealing with psoriatic nails, read on for treatment options that can hopefully offer you hope as well.

Relief is possible

Psoriatic nails show up in many ways and can be downright painful. Untreated, they can make you more likely to develop fungal infections, and because they’re often discolored and misshapen, they might be embarrassing.

But this condition goes beyond embarrassment: Research suggests that people with psoriatic nails self-score as having a lower quality of life (QoL) than people without psoriatic nails. So this isn’t simply about feeling shy when going barefoot or shaking someone’s hand.

This isn’t the first time we’ve addressed psoriatic nails at Bezzy. If you’ve read about them here before, you may know that options for treatment include topically applied creams and ointments or systematic treatments like methotrexate which has been shown to effectively treat psoriatic nails with no evidence of recurrence.

Immune-suppressing drugs taken orally, or by injection, can also reduce psoriatic nail symptoms. Talk with a rheumatologist about any of these options.

Psoriatic nail self-care

Some additional self-care options out there might not be on your radar. These are especially helpful if you’re like me, someone whose psoriatic nail symptoms are still relatively mild.

Here are a few things to consider:

Let there be light

While you may know that targeted laser therapy can treat psoriatic nails, you might not know about low-level light therapy, or LLLT, including ultraviolet light (UV) and near-infrared light therapy (NIR), which has been around since 1967.

UV therapy can help reduce psoriatic skin symptoms, and research from 2015 suggests that NIR might work better at reducing inflammation and promoting the regeneration of damaged tissues in conjunction with UV light, or even on its own.

One additional type of LLLT, known as red light therapy (RLT) operates at a lower frequency and has become ubiquitous at tanning salons.

Though RLT is more often associated with helping psoriatic skin lesions, some people may find it improves their psoriatic nails. And since most local tanning salons offer LLLT options, it’s worth trying out for yourself to see if it works for you.

Before beginning any treatment, discuss your options with a healthcare professional to go over the benefits and potential risks. For example, UV light exposure may increase your risk of developing skin cancer.

Can mama nature help?

I’ve read that aloe vera can help soften psoriatic nails, and I’ve had some success with this. Some people also suggest that other natural sources — like Manuka honey — may be helpful in treating psoriatic plaques.

But have you ever heard of Lindioil? (Neither had I). The main ingredient is indigo naturalis, a Chinese herb. This herb has been tested for its effectiveness in safely treating psoriatic nails for over a decade.

In a small 2014 study, Lindioil reduced the nail psoriasis severity index (NAPSI) in patients by over 50%, which is quite significant. A quick web search of indigo naturalis brings up a plethora of products made with this herb, often combined with other soothing oils, such as jojoba and almond. Definitely worth a try.

Try a visit to the foot doctor

As recently as 2018, it was estimated that less than 10% of the American population visited a podiatrist. These doctors are being underutilized and can be especially helpful to older adults who may have limited flexibility and cannot care for their own feet very well.

Podiatrists are medical doctors, but they don’t simply address foot issues such as bunions and plantar fasciitis. They treat the overall health of the feet and can help evaluate the state of your psoriatic nails.

A regular visit might include a brief foot soak and a nail filing comparable to any nail salon, as well as medical advice and prescriptions.

You may need a referral from your primary care physician, but adding a podiatrist to your healthcare team could be invaluable.

Pamper yourself with a pedicure

Because psoriatic nails are fragile, and sometimes bleed, it’s very important to vet any manicurists at a local nail salon.

Inquire if anyone there has experience with psoriatic nails and knows that soaking them too long, or filing too firmly, can make them worse — and cause a lot of discomfort for a client with psoriasis.

Even if they say no, if they’re open to learning, it’s worth working with someone through the do’s and don’ts of a psoriatic-safe manicure.

Besides the aforementioned concerns, the American Academy of Dermatology Association recommends avoiding fake nails of any kind. But a few light coats of nail polish can help stabilize nails and protect them, and also camouflage any pitting or discoloration you may have.

While I was never a fan of painted toenails in the past, I now find that I like looking down at them when they’re nicely filed and painted, and I feel more confident wearing sandals in warm weather. So finding the right manicurist, or giving yourself regular mani/pedis at home can make a huge difference.

Bottom line

While I hope all of these suggestions are helpful, we here at Bezzy always want to remind you to reach out to your medical team when you need more advice, or when you notice any progression of your psoriatic symptoms.

Your rheumatologist and your dermatologist — and your podiatrist if you have one — are the most qualified to help you make decisions about new treatment plans and options. And for community support and shared experiences, keep coming back to Bezzy. You’re in good company here.