Psoriasis is a chronic inflammatory skin condition. Often people will suffer from dry skin patches on their skin but psoriasis can also involve nails and joints.
Up to 65% of people who suffer with psoriasis will have some involvement in the nails. Unfortunately, nail psoriasis is often underreported because it can be seen as insignificant or cosmetic.
But when I see patients in clinic they feel isolated and too embarrassed to mention this and they hide it away with polish, socks and shoes.
Your body creates new skin cells from the deepest layer of the skin.
Every 3-4 weeks your body creates new skin cells, and the dead skin cells flake away.
Psoriasis is caused by inflammation within your body.
If you suffer from psoriasis, your body will create new skin cells a lot faster - every 3-7 days.
This results in plaques of skin building up, becoming flakey or crusty.
What happens with Nail Psoriasis?
During a flare up of psoriasis more skin in produced and this quickly builds up to leave plaques of excess dry skin, on the nail bed underneath the nail.
This causes the nail to lift.
Skin cells become trapped.
This leaves the nail looking white and crumbly.
Underneath the nail the skin repeatedly builds up and is unable to shed away. This is why it is often misdiagnosed as a fungal nail infection.
How to identify nail psoriasis ?
During our online consultations and in clinic we use PASI Psoriasis Area and Severity Index and NAPSI Nail Psoriasis Severity Index Scores to monitor each patients progress.
Your Podiatrist will look for;
Nail Pitting,
Crumbling Nail
Loosening of the nail plate from the nail bed
Nail discolouration
Your Podiatrist will also ask some medical questions about your health and your families health. This helps to build a picture and see if you are at risk of an inflammatory condition.
Treatment
If your podiatrist determines that you have psoriasis in your nails, there are a range of treatment available.
First we will discuss your lifestyle and see if there is a stressful event causing the psoriasis to flare.
Identifying the exact location of psoriasis under the nail plate is key to determining how and where topical medications should be applied.
Therapies available include Laser, Calcipotriol ( a vitamin D analpgue), Corticosteroids, Retinoic Acid.
There is also a strong prevalence of fungal infections being present in psoriatic nails. Due to the nail becoming damaged, the nail lifts from the nail bed and provides an entry way for fungal spores to grow. Many patients present to clinic with psoriatic nails where a fungal nail infection is present. This is why in some cases it is important to treat both.
If you have any concerns please do not hesitate to get in touch.
Start your treatment plan today! Book an online consultation.