If you live with psoriatic arthritis (PsA), you may notice changes not only in your joints and skin but also in your fingernails and toenails. Up to 80% of people with PsA experience nail symptoms such as pitting, thickening, crumbling, or separation of the nail from the nail bed. These changes can be more than cosmetic—they may cause discomfort, pain, and emotional distress that affect daily life.

Understanding how psoriatic arthritis impacts your nails can help you recognize early warning signs and seek appropriate treatment to maintain nail health and function.

What Is Psoriatic Arthritis?

psoriatic arthritis is a chronic autoimmune disease that triggers inflammation in your joints and surrounding tissues. It is closely linked to psoriasis, a skin condition that causes red, scaly patches. PsA typically develops 7–10 years after psoriasis appears, but it can also occur before or without skin symptoms.

PsA can affect large joints (such as the knees and shoulders) as well as smaller joints in the fingers, toes, spine, and pelvis. In some cases, it may also impact the nails, eyes, and internal organs. Early diagnosis and treatment are vital to prevent permanent joint damage and improve long-term quality of life.

Why Psoriatic Arthritis Affects Your Nails

Your nails are made from keratin, the same protein found in your skin and hair. Because nails are considered extensions of the skin, inflammation from psoriasis and PsA can easily affect nail tissue.

In psoriatic arthritis, the immune system attacks both joint tissues and skin cells, leading to rapid skin cell turnover. This can cause the nail matrix (where nails grow) and nail bed (the skin beneath the nail) to become inflamed. As a result, nails grow abnormally and show visible damage.

Fingernails are more commonly affected than toenails because they grow faster. In some people, nail changes appear before joint symptoms, serving as an early sign of PsA. Those who already have nail psoriasis are also at higher risk of developing psoriatic arthritis.

What Do Psoriatic Arthritis Nails Look Like?

PsA can affect one or both parts of the nail structure:

  • Nail matrix: The tissue under the nail base responsible for new nail growth.

  • Nail bed: The skin beneath the nail plate that anchors the nail.

Common nail changes in psoriatic arthritis include:

  • Pitting: Tiny dents or depressions on the nail surface caused by inflammation in the nail matrix.

  • Deformation: Changes in the shape or structure of the nail plate, making nails uneven or misshapen.

  • Onycholysis: Separation of the nail from the nail bed, often leaving a gap where debris can collect.

  • Thickening: The nail becomes raised and uneven due to flaky buildup under the nail plate.

  • Beau’s lines: Horizontal ridges or grooves across the nail caused by temporary interruptions in nail growth.

  • Discoloration: Nails may appear yellow-brown or have oil-like “salmon patches.”

  • Fungal infection (onychomycosis): PsA-damaged nails are more prone to secondary fungal infections.

These symptoms may affect one or several nails and often appear alongside joint pain or skin flare-ups.

When To Contact a Healthcare Provider

If you have psoriasis or psoriatic arthritis, regular nail checks can help catch symptoms early. Contact your healthcare provider if you notice:

  • Small pits or dents in your nails

  • Yellow, brown, or white discoloration

  • Thickened, crumbling, or brittle nails

  • Flaky buildup or bleeding beneath the nail plate

Early treatment can restore nail health and prevent complications such as infection, pain, and permanent deformity. Your provider may refer you to a rheumatologist (for joint inflammation) or a dermatologist (for skin and nail symptoms).

Treatment and Nail Care

Although nail psoriasis can be challenging to treat, combining medical therapy with proper nail care can significantly improve nail health and reduce discomfort.

self-care practices:

  • Keep nails short, clean, and trimmed to reduce pressure and debris buildup.

  • Avoid picking or biting nails and cuticles to prevent further injury.

  • Use thick moisturizers or ointments to keep hands and cuticles hydrated.

  • Wear gloves during cleaning, gardening, or home repairs to protect nails from trauma.

  • Avoid acrylic nails or harsh chemicals; instead, opt for gentle buffing and nail polish.

  • Do not scrape debris from under the nails, as it may increase infection risk.

medical treatments:

  • Topical medications: Corticosteroid creams or ointments applied directly to nails to reduce inflammation.

  • Corticosteroid injections: Small doses injected into affected nails to improve thickness and appearance.

  • Phototherapy (light therapy): Controlled UV light exposure to decrease inflammation and help nail regrowth.

  • Systemic medications: Oral or injectable DMARDs (disease-modifying antirheumatic drugs) or biologics for more severe or widespread PsA. These treatments control inflammation throughout the body and may also improve nail and skin symptoms.

Living With Psoriatic Nail Changes

Nail involvement in psoriatic arthritis can affect your daily activities, confidence, and emotional well-being. While complete healing can take several months, consistent treatment and self-care can make a visible difference.

If you have PsA, managing your overall inflammation with prescribed medications will often improve both joint and nail symptoms. In the meantime, focus on protecting your nails, reducing stress, and maintaining a healthy lifestyle to support recovery.

A Quick Review

Psoriatic arthritis can cause a wide range of nail changes, including pitting, discoloration, thickening, and nail separation. These symptoms occur because PsA affects the skin cells and nail structures that grow from the same tissues as the skin.

Early diagnosis and appropriate treatment—ranging from topical creams to systemic biologics—can restore nail health and prevent long-term damage. By combining medical care with proper nail hygiene, people with PsA can significantly improve their nail appearance, comfort, and quality of life.