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Nail psoriasis occurs in approximately 50% of patients with psoriasis vulgaris and over 80% people with articular psoriasis. In the course of nail psoriasis, the changes may be of various types, of which the most common and causing the greatest problems for patients is pimples. What are the causes and symptoms of nail psoriasis? What is the treatment? Will over-the-counter medications help?

Nail psoriasis(psoriatic nail changes) occurs in approximately 50% of patients with psoriasis vulgaris and over 80% people with articular psoriasis.

Nail psoriasis - causes

It is not known what causes psoriasis. Some specialists agree that it is an autoimmune disease, which means that for some unknown reason the body starts attacking and destroying its own tissues. However, there is a whole list of factors that can be both a trigger and cause a relapse in psoriasis in people who are predisposed to it, including:

  • acute and chronic infections, e.g. streptococcal and viral angina, e.g. measles, smallpox, shingles, rubella, chronic sinusitis, caries, recurrent cystitis, adnexitis, gallbladder, hypertrophic tonsils
  • chronic diseases - diabetes, gout
  • drugs - some antibiotics, e.g. tetracyclines, lithium s alts, beta blockers, steroids, interferon, hormonal drugs
  • stress - both acute and chronic, any mental shock

Nail psoriasis - symptoms

The changes found within the nails depend on the location of the psoriatic process. When the disease affects the nail matrix, the following may appear:

  • pimples - single cavities are formed in the nail plate. They are relatively large, deep, irregular in shape, and randomly located on the nail plate. Thimbles are mainly observed in the fingers, but sporadically in the toes.

In some cases, nail plates are the only location of psoriasis, but more often such changes accompany typical psoriatic thyroid glands elsewhere.

Thimble is the most common symptom in both adults and children, occurring in approximately 70% of adults. patients with psoriasis and nail lesions. It is an undoubted sign of activitydisease process, often preceding the appearance of skin lesions, especially in children.

  • Beau lines - are linear, transverse depressions within the nail plate
  • longitudinal furrowing
  • trachyonychia - uneven surface of the entire nail plate
  • dystrophy (crumbling) - trachyonychia changes and pimples are very intense and the nail plate often crumbles
  • leukonychia - discoloration within the nail plate
Worth knowing

Nail changes in the course of psoriasis have a large impact on the mental state of the patient, because they are, like the eruptions on the skin of the hands and face, the most visible. In 93 percent of patients, they are a cosmetic problem, in 52 percent. nail changes are painful, and 58 percent. cause difficulties in everyday activities. Increased changes in the nail plates in the course of psoriasis are associated with significant anxiety and depression.

When the disease affects the nail bed, the following may appear:

  • oil stains (salmon) - this is the second most common symptom of nail psoriasis (after pimulation), which also proves the activity of the disease process. Oil stains are visible in the nail plate round, oval, yellowish foci. Usually they are single, but sometimes two or three can be observed. Often, in the first period, the oil stains are not yellowish, but only a focal intensification of the color of the plate to a more pink, red is observed. During this time, patients usually experience tenderness and soreness in their nails

In some people, changes in the nail plates appear many years before the appearance of typical psoriasis on the skin.

  • onycholysis - separation of the nail plate from the placenta. As a result of onycholysis, a space is created under the nail plate, which is a favorable environment for the development of microorganisms, therefore, in the case of the above changes, there is a risk of bacterial infections
  • subungual keratosis
  • Linear splintig haemorrhages are the presence of long, several millimeters, dark red streaks within the plate resulting from placental trauma

The most severe lesions in the fingertips (mainly the hands), with the presence of painful pustular lesions, are a separate problem, occurring in a very rare form of pustular psoriasis. They can lead to complete atrophy of the nail plate and even shortening of the distal phalanx and contractures in the jointsinterphalangeal.

Nail psoriasis - diagnosis

The above symptoms may also appear in other dermatological diseases, which often causes great difficulties in the diagnosis of nail psoriasis. In practice, the most important differentiation is from onychomycosis.

According to an expertDr. Elżbieta Szymańska, MD, a dermatologist

My husband has a problem with his hands. At first his hands ached, then he got spots, then the skin of all his hands started to peel off, and now his fingernails are starting to come off. What could it be?

Dr. Elżbieta Szymańska, MD, dermatologist: Your husband should see a dermatologist. The described changes should be differentiated, among others, with pustular psoriasis, hand eczema, and mycosis. In order to establish the diagnosis, it is necessary to perform a medical examination and any additional tests (including skin biopsy).

Nail psoriasis - treatment

Treatment of nail psoriasis is very complicated. Topical corticosteroids, 5-fluorouracil, anthralin, retinoids (tazarotene) and a vitamin 03 derivative (calcipotriol) are used with little effect. Systemic treatment with methotrexate, retinoids (acitretina) and immunosuppressants (cyclosporine) in patients with generalized psoriasis also improves nail plates.

Also PUVA phototherapy has a positive effect on the nail plates in the course of psoriasis. However, the optimal therapy for nail plate lesions in psoriasis vulgaris has not yet been established. Hopes are connected with new biological medicines. The first reports indicate a beneficial effect of infliximab on nail psoriasis, however, long treatment is required to achieve a good effect.

According to an expertDr. Elżbieta Szymańska, MD, a dermatologist

Treatment of nail psoriasis. Diet for nail psoriasis

Is there a drug to help treat nail psoriasis? Does diet affect the condition of the skin in psoriasis?

Dr. Elżbieta Szymańska, MD, dermatologist: Treatment of nail psoriasis is very difficult. The method of treatment depends on the advancement of the changes. The changes disappear best with general therapy with tablets, however, you need to remember about the possible side effects of these drugs and the need to monitor the therapy by your doctor. You can also try to use external medications, such as steroids or vitamin D3 derivatives, but the expected effect in these cases is weaker.

Dermatologist: Lamp irradiation under the supervision of a doctor is a good way to get rid of psoriasis

Source: x-news.pl/Dzień Dobry TVN /

Nail psoriasis and hybrids

Theoretically nail psoriasisis a contraindication to performing a hybrid manicure, mainly because it may contribute to the deterioration of the nail condition. However, on internet forums you can read different opinions - some Internet users write about the occurrence of onycholysis after using acrylic and hybrid for a long time, and others write about strengthening the plate and protection against bending.

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Category:

Dermatology