Psoriatic Nail Changes

A 26-year-old woman is upset about the appearance of her nails. The latter have been changing over a 6 month time period. Family history disclosed an aunt and cousin with psoriasis.

Key point: The two changes seen in the depicted nail are small pits and separation of the nail plate from the nail bed (onycholysis). While each has a long list of systemic associations, the one disease where both findings can be seen concomitantly is psoriasis.

Treatment: There is no surefire treatment for psoriatic nail changes. Application of potent topical steroids to the posterior nailfold/cuticle area may help, as may intradermal steroid injections into the nail matrix. Biologic drugs, while not usually given just to ameliorate nail disease, usually do so when given for moderate to severe cutaneous psoriasis or psoriatic arthritis.

Note: Psoriatic nail involvement increases the patient’s risk that psoriatic arthritis will eventually develop.