Nail psoriasis

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Nail psoriasis

Nail psoriasis is a prevalent manifestation of psoriasis, affecting up to 50% of individuals with the condition.

Nail psoriasis can often serve as an early indicator of psoriatic arthritis, and its presence increases the likelihood of developing joint symptoms. In fact, studies show that approximately 15-20% of people with nail psoriasis will go on to develop psoriatic arthritis. Conversely, around 30% of individuals with psoriatic arthritis will have nail involvement, making it an important symptom to monitor in these patients.

The significance of nail psoriasis goes beyond cosmetic concerns. While the condition itself can cause discomfort, such as pain and tenderness, it may also lead to functional issues. Nails affected by psoriasis can become thickened, discolored, or brittle, making everyday activities like grasping objects or typing more difficult. In severe cases, nails may become detached from the nail bed (onycholysis), leaving them vulnerable to infection. This can lead to further complications, including permanent nail deformities, which can have a profound impact on a patient's self-esteem and overall quality of life.

It is crucial to treat nail psoriasis promptly to prevent these consequences. Treatment options, including topical therapies, intralesional injections (injections of cortisone into the nail fold), systemic medications, and phototherapy, can help manage symptoms and prevent further damage to the nails. If left untreated, nail psoriasis can also be associated with the development of more severe joint involvement in psoriatic arthritis, potentially leading to more extensive disability.

Nail psoriasis can sometimes be mistaken for other conditions, such as fungal infections, eczema, or trauma-related nail changes. To distinguish between these conditions, a dermatologist will typically perform a thorough examination, considering the patient's medical history and performing tests such as a nail biopsy or fungal microscopy (KOH) and culture. For example, fungal infections typically present with more distinct changes like thickened, yellowed nails without the pitting seen in psoriasis, while eczema-related changes often affect the surrounding skin as well. Proper diagnosis and treatment are essential to manage nail psoriasis effectively and prevent further complications.