Psoriasis is a long-term inflammatory skin disorder that causes raised, scaly patches on various areas of the body, such as the scalp, knees, elbows, hands, and feet. Nail psoriasis is a form of this condition that specifically impacts the nails, affecting as many as 80% of individuals who have psoriasis.

Unlike psoriasis on the skin, nail psoriasis does not produce scaly patches on the nail surface. Instead, it presents distinct nail-related symptoms. For some people, nail psoriasis appears years after a psoriasis diagnosis, while others experience nail symptoms before skin symptoms ever show up. Regardless of when it develops, nail psoriasis can significantly impact your quality of life.

Nail psoriasis symptoms

While skin psoriasis typically causes red, raised, scaly patches, nail psoriasis affects the nail in several different ways. Common signs include:

Nail pitting
Small indentations form on the surface of the nail. You may see one or many on the same nail.

Hyperkeratosis
Excess skin cell buildup under the nail can result in a chalky substance that causes discomfort or pain as it separates the nail from the nail bed.

Discoloration
Nails may become yellow or brown and can sometimes develop circular stains that resemble oil spots or salmon patches.

Onycholysis
This refers to the nail pulling away from the nail bed, often leading to pain or vulnerability to infection.

Onychomycosis
Thickening of the nail caused by a fungal infection may occur as a result of nail changes.

Weakening or crumbling
The nail structure can become fragile enough to break, split, or crumble entirely.

What causes nail psoriasis

Nail psoriasis is generally linked to underlying psoriatic inflammation, such as plaque psoriasis or psoriatic arthritis. Psoriasis causes the immune system to overproduce skin cells, which can lead to structural changes in the nail bed and surrounding tissues.

Although other autoimmune diseases like lupus or rheumatoid arthritis can cause similar nail symptoms, they do not cause nail psoriasis itself.

Risk factors

While there are no risk factors specific only to nail psoriasis, several elements increase the likelihood of developing psoriasis or psoriatic arthritis, both of which can lead to nail symptoms.

  • Family history: Having a close relative with psoriasis or PsA increases your chances of developing either condition.

  • Certain medications: Beta-blockers, lithium, and some antibiotics have been linked to a higher risk.

  • Stress: Chronic stress can trigger immune dysfunction, leading to symptom flare-ups.

  • Infections: Serious infections such as strep throat can activate the immune system and spark psoriatic symptoms.

  • Skin injury: Trauma, including cuts or severe sunburns, can provoke a flare in those predisposed to psoriasis.

Diagnosis

Nail psoriasis affects both the nail plate and the underlying nail bed. Diagnosing it often involves a physical exam and additional tests to rule out other conditions, such as fungal infections.

Dermatoscopy
This non-invasive procedure uses magnification and lighting to closely examine the nail surface for patterns typical of psoriasis.

Capillaroscopy
Providers observe small blood vessels at the nail base under magnification to identify capillary changes linked to psoriatic disease.

Biopsy
A small sample may be taken from the nail or surrounding tissue to confirm the diagnosis under microscopic evaluation.

Nail psoriasis treatment

Although nail psoriasis cannot be cured, treatments are available to reduce symptoms and improve nail appearance. Treatment depends on severity.

Topical treatments
Mild nail psoriasis can often be managed with steroid creams, vitamin D-based medications, or calcineurin inhibitors applied directly to the nail. In some cases, steroid injections or laser treatments may also be used.

Systemic treatments
Moderate to severe nail psoriasis—especially when accompanied by skin or joint involvement—may require systemic drugs such as methotrexate or biologic medications. These therapies reduce inflammation by targeting the immune system and are usually taken orally or by injection.

Prevention

While psoriasis itself is not preventable, there are steps you can take to reduce flare-ups and minimize nail damage.

  • Keep nails clean and dry

  • Moisturize hands and nails daily with ointment-based creams

  • Avoid biting or picking at nails and cuticles

  • Use gloves when doing household chores or manual labor

  • Avoid harsh nail treatments like gels or acrylics

  • Do not scrape under the nails with sharp objects

Related conditions

While nail psoriasis on its own does not typically lead to other health issues, it is often associated with broader psoriatic disease. Common related conditions include:

Psoriatic arthritis (PsA)
About 30% of people with psoriasis develop PsA, a condition marked by joint pain, swelling, and stiffness. Nail involvement can be an early indicator of future joint damage.

Heart disease
Chronic inflammation in moderate to severe psoriasis may increase the risk of cardiovascular issues like heart attack or stroke.

Type 2 diabetes
Psoriasis has been linked to insulin resistance, potentially raising the risk for developing diabetes.

Obesity
This can act as both a trigger and comorbidity, intensifying immune responses and complicating disease management.

Living with nail psoriasis

Nail psoriasis does not affect life expectancy on its own. However, when it coexists with broader psoriatic disease, such as PsA, it can diminish overall quality of life.

Severe nail psoriasis can cause physical discomfort and emotional distress due to cosmetic concerns. If symptoms become painful or interfere with daily life, speak with a healthcare provider about available treatments.

Early diagnosis and a personalized treatment plan can help improve symptoms, prevent flare-ups, and reduce the psychological burden associated with the condition.