Nail psoriasis

Skin psoriasis is a fairly well-known and widespread disease that is accompanied by a disruption of normal cell division. However, not many people know that there is another similar pathology that affects the nail plate - nail psoriasis. The disease has much in common with common psoriasis and is characterized by the layering of cells on top of each other. Thus, so-called psoriatic plaques are formed.

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Causes nail psoriasis

Nail psoriasis is diagnosed relatively rarely and, as a rule, accompanies other types of psoriasis: for example, psoriatic skin or joint lesions. Rarely, nail psoriasis is an independent disease.

To date, scientists have not fully understood the etiology of the disease.

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Risk factors

Risk factors that can influence the occurrence of nail psoriasis have been identified:

• frequent or prolonged stressful situations;
• metabolic disorders;
• systemic chronic diseases;
• insufficient peripheral circulation;
• excessive sensitivity to cold or other external factors;
• unfavorable heredity;
• disruptions in the functioning of the immune system;
• hormonal imbalance.

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Pathogenesis

The pathogenesis of nail psoriasis consists of a disorder of cell proliferation and differentiation.

1. The cell cycle is shortened.
2. An excessively large number of cells are formed.
3. Growths and thickenings appear on the nail plate.

It is generally accepted that psoriasis is a polyetiological disease. The epidemiology of the disease is as follows: up to 40% is the result of family pathology, up to 25% is a consequence of other psoriatic processes in the body. The overall prevalence of psoriasis on the planet is about 3%. The disease is not contagious and does not pose a danger to others.

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Symptoms nail psoriasis

The clinical symptoms of nail psoriasis are varied, but there are also characteristic signs by which the disease can be identified.

The first signs of the disease are clouding of the nail plate. Also, grooves of different directions appear on it, small depressions over the entire surface of the nail, which resemble the surface of a sewing thimble. This phenomenon is called the "thimble" symptom.

The second sign of nail psoriasis is onycholysis - this is the separation of the plate from the nail bed, which occurs without obvious inflammatory changes. Most often, the detachment begins from the distal part and affects part or the entire plate.

A void gradually forms under the nail, where dirt, epithelial particles, etc. accumulate over time. Because of this, the nail acquires a dirty white color, and sometimes an unpleasant odor is felt.

The next stage of nail psoriasis development is the appearance of subungual hemorrhages, which are pinkish or reddish spots, up to dark brown or black. The darkening of the spots is the result of capillary rupture.

The last characteristic sign of psoriatic lesions is considered to be trachyonychia - this is clouding and roughness of the nail plate, which becomes flat and even slightly concave.

Nail psoriasis in children is rare, accounting for approximately 15% of all cases of childhood psoriasis. Signs of the disease often precede skin manifestations of psoriasis, which can be detected even several years after the nail symptoms.

Forms

As we have already said above, nail psoriasis has several successive stages of progression:

• Stage I – “thimble” symptom;
• Stage II – onycholysis stage;
• Stage III – hemorrhagic;
• Stage IV – trachyonychia.

In addition, there are also separate types of nail psoriasis.

• Thimble psoriasis of the nails is the most common manifestation of the disease, which is characterized by the predominance of such a sign as the thimble symptom: a scattering of tiny depressions on the nail surface.
• Complete or partial onycholysis – the prevalence of painless detachment of the nail plate.
• Central, distal or lateral onycholysis is a painless, directional separation of the nail.
• Onychomadesis is a rapid detachment of the nail.
• Psoriatic paronychia is a symptom that accompanies the generalized course of psoriasis. It is characterized by inflammation and thickening of the cuticle and skin near the nail.

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Complications and consequences

Nail psoriasis is a disease that cannot be cured completely. Often, patients manage to achieve a decrease in symptoms, which eventually reappear.

Psoriatic nail lesions usually precede or occur against the background of a general form of psoriasis, so one of the complications may be atherosclerotic changes in blood vessels and cardiovascular diseases.

Sometimes psoriasis can also result in psychological problems associated with the rejection of the sick person by others. Often, in order to escape the problem, patients unconsciously acquire new pathologies: alcoholism, depressive states, neuroses. Serious mental disorders can result in heart and endocrine diseases, and the development of oncological diseases.

Long-term psoriasis can visually change a person's nails and skin, which negatively affects their social adaptation. Such people often become withdrawn, secretive, and lead an isolated lifestyle.

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Diagnostics nail psoriasis

As a rule, a dermatologist can determine and diagnose nail psoriasis by its appearance. In some cases, additional studies are required to help put the final point in the diagnosis. As a rule, the doctor will first prescribe tests:

• general blood test (leukocytosis, increased ESR);
• analysis of a biopsy (an element of the skin near the nail, or psoriatic scale).

Instrumental diagnostics are usually not performed.

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Differential diagnosis

Differential diagnostics is one of the main points of diagnosis. Thus, nail psoriasis in some cases can be mistaken for paronychia and onychia of fungal or microbial etiology, or for dystrophic changes in the nail. Psoriasis and fungal infection of the nail plates are especially often confused. A logical question arises: how to distinguish nail fungus from nail psoriasis?

When a nail is infected with a fungus, purulent contents with an unpleasant odor often accumulate under the plate, and the disease itself manifests itself not on a specific finger, but on all the nails of the upper or lower extremities.

Diagnosis is complicated if a patient is diagnosed with psoriasis and a positive fungal culture is obtained at the same time.

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Treatment nail psoriasis

Since the disease is considered incurable, the treatment process becomes long and painstaking, and continues throughout life. All procedures are aimed at prolonging the remission stage and easing the patient's well-being.

Along with the main treatment, there are some recommendations that doctors give to their patients:

• It is necessary to always keep your nails short;
• it is unacceptable to resort to trimming the cuticle, to manicure and pedicure procedures on the affected nails. It is necessary to remember once and for all: manicure with nail psoriasis, as well as nail extensions with psoriasis cannot be carried out;
• hangnails should be removed with fine-grained manicure files, which will make the nails look neater;
• To prevent infection, it is recommended to cover the nail plates with a special varnish;
• It is advisable to perform any work wearing protective gloves;
• In case of psoriasis of the nails of the lower extremities, it is preferable to wear shoes that are slightly larger in size to prevent compression of the toes;
• Appropriate ointments or creams should be applied regularly to nourish and moisturize the fingers and nails.

Treatment of psoriasis is always combined, since it is inappropriate to use any one remedy: a comprehensive approach is necessary. It is important to promptly treat chronic and other diseases, support the immune system and the nervous system.

• Treating nail psoriasis at home is possible, but requires some effort and patience. In order to gain control over the disease, experts advise following these rules:
  • follow a diet or take supplements with a high calcium content;
  • in case of discomfort and itching, take antihistamines (for example, suprastin, diazolin, etc.);
  • observe the rules of personal hygiene, wash your nails with an infusion of medicinal herbs (St. John's wort, sage);
  • lubricate the affected areas with vegetable oils every night;
  • maintain immunity, periodically take multivitamin complexes;
  • The main treatment should be carried out only under the supervision of a doctor.

Additionally, you can use traditional medicine recipes and other types of treatment, which we will discuss below.

• Medicinal varnishes for nail psoriasis:
  • Nail Tek Xtra – a treatment for weak and thin nails;
  • Blaze Nail Force – varnish for intensive strengthening of nail plates;
  • Nail Tek II Intensive Therapy is a product for thin and flaking nails.

Experts claim that regular clear nail polish also has some healing effect: it protects the affected areas from infection and makes the nail plate glossy and more attractive.

• Medicines for nail psoriasis are prescribed individually, since the manifestations and severity of the pathology in patients may be different. Various groups of drugs are used for treatment, the need for which is determined by the doctor.

	Method of administration and dosage	Side effects	Special instructions
Treatment with hormonal ointments
Triacort	Apply a thin layer up to 3 times a day.	Itching and burning.	Do not use for viral and fungal infections, syphilis and tuberculosis of the skin.
Triamcinolone	The ointment is applied up to 3 times a day.	Swelling, rashes.	Not prescribed during pregnancy, as well as for viral and fungal skin diseases.
Prednisolone	Apply a thin layer up to 3 times a day. Duration of therapy is up to 2 weeks.	Itching, burning sensation, development of folliculitis.	It is not recommended to apply to large areas of skin.
Ointment for nail psoriasis
Lorinden	Apply 2 times a day for no more than 2 weeks.	Dry skin, itching sensation.	Do not use in the first trimester of pregnancy or in small children.
Salicylic ointment 2%	Apply up to 3 times a day, from one to three weeks.	Occasionally – dryness and irritation of the skin.	None.
Zinc ointment	Apply 3 times a day. Duration of treatment is determined individually.	With prolonged use, skin irritation may occur.	Can be used in pediatric practice.
Nail Psoriasis Cream
Pikladol	Apply up to 3 times a day. Duration of therapy is 3 months.	Not observed.	None.
Sophora	Rub in up to 4 times a day every day for one month.	None.	None.
Psorilom	Apply up to 3 times a day without rubbing.	Allergic manifestations.	Do not use to treat children.
Proscutan (Psorcutan)	Proscutan for nail psoriasis is used 2 times a day. The course of treatment can be long, from 2 to 12 months.	Dryness, skin irritation, allergies, hyperpigmentation.	Not prescribed during pregnancy and lactation, as well as in case of psoriatic lesions of more than 30% of the body surface.
Dermatotropic drugs for nail psoriasis
Anthralin	Apply a thin layer, avoiding healthy areas of skin, once a day. The course of therapy is 1.5-2 months.	Allergy, swelling, skin irritation.	The ointment is washed off only with warm water without adding detergents.
Micanol	Apply to affected areas of skin 1-2 times a day.	Allergy and pigmentation of nearby healthy skin.	When applying, use protective gloves.
Dithranol	Use once a day.	Changes in the structure of surrounding healthy skin.	Not used in pediatrics.
Retinoids for nail psoriasis
Tretinoin	Apply twice daily to clean skin.	Allergic reactions.	Not used during pregnancy and lactation.
Tazarotene	Apply a thin layer at night.	Itching and burning sensation, hyperemia.	Do not apply to open wound surfaces.
Benzoyl peroxide	Use 1-2 times a day, preferably at night.	Dry skin, irritation.	Has a whitening effect.

• Vitamins are a necessary addition to the general treatment of nail psoriasis. This should be remembered both when choosing mineral and vitamin preparations and when composing a diet for psoriasis. We present to your attention a list of vitamins, the presence of which will significantly alleviate the course of the disease.

1. Vitamin A – helps eliminate inflammatory changes in the skin. It is rich in such products as bell peppers, cream, sour cream, liver.
2. Vitamins of group B – normalize the nervous system, promote cellular metabolism. Contained in buckwheat, nuts, liver.
3. Ascorbic acid – supports immunity, strengthens capillaries. Vitamin C is found in sufficient quantities in rose hips, berries, kiwi, citrus fruits.
4. Vitamin D is a universal dermatological remedy. The source of the vitamin is ultraviolet rays.
5. Vitamin E is an antioxidant that eliminates inflammation and allergies. It is found in sufficient quantities in almost any unrefined vegetable oil.

If there is a need to take multivitamins for nail psoriasis, you can choose one of the following drugs:

• Vitrum Beauty is a specially created complex to support and improve the health of nails, skin, and hair. For psoriasis, take 1 tablet three times a day.
• Multitabs intensive - a rich vitamin-mineral composition helps support the body during stress and strain, replenishes the lack of vitamins and microelements. It is recommended to take 1 tablet per day, with food.
• Merz special dragee is a balanced complex, indispensable for the treatment of psoriasis. The recommended dosage is 1 dragee per day.
• Centrum is a combination drug that normalizes the process of cell division. It serves as a preventative measure against malignant tumors. Daily dose is 1 tablet.

Some patients use oil solutions of vitamins as external remedies for psoriasis. Sometimes such use is justified and has some therapeutic effect. For example, vitamin A externally for nail psoriasis prevents the development of the inflammatory process, heals and strengthens tissues. The only condition: the drug should be used regularly, twice a day (in the morning and at night), lightly moistening the affected surface. Do not rub the solution!

• Another method of therapy for psoriasis is physiotherapy. They use ultraviolet radiation, the rays of which have a cytostatic and antimitotic effect. The affected areas are pre-treated with raw tar or dithranol.

In addition, photochemotherapy is used – the so-called PUVA therapy. This treatment is especially effective in combination with retinoids.

Dynamometry, magnetic therapy, UHF, phonophoresis (with hormonal drugs), and cold therapy are also used in the treatment of psoriasis.

• Folk treatment of nail psoriasis can be actively used in the initial stages of the disease:
  • baths using a decoction of bay leaf. Pour 40 g of leaf per 1 liter of boiling water, boil for 10 minutes. Dip hands or feet in a warm decoction for a quarter of an hour. In addition, bay leaf for nail psoriasis can be taken internally, 40 ml of the prepared decoction three times a day;
  • a compress of 0.5 l of warm water, 2 tbsp of oatmeal and the same amount of starch;
  • baths with the addition of gelatin. Soak 2 teaspoons of gelatin in 200 ml of cool water, then heat the solution to body temperature and dip the affected fingers into it for a quarter of an hour. After the procedure, lubricate the fingers and nails with cream or ointment.

Herbal treatment can also be used for generalized psoriasis. In this case, plants are used both as an external and internal remedy.

Internally, you can take infusions of herbs such as nettle, calamus, elecampane, St. John's wort, succession, chamomile. They are brewed and drunk as tea throughout the day.

Celandine is most often used to prepare herbal baths. Take 2 liters of boiling water for 50 g of raw material and keep it under a lid for at least 1 hour. This infusion is no less effective for compresses.

A compress based on common cocklebur is useful for psoriasis. Brew 4 tbsp of the herb in 0.5 l of water and apply to the affected areas. Cover with cellophane and a towel. Leave for 15 minutes. The procedure can be repeated daily.

A good effect is expected from the constant use of an infusion based on St. John's wort, calamus rhizome, celandine, string, and lingonberry leaves. 1 teaspoon is poured with 250 ml of boiling water. Take 50 ml twice a day.

Treatment of nail psoriasis with birch tar is very common. The affected area is lubricated with tar once a day. The first procedure should last no more than 10 minutes. Then the duration of keeping the tar on the nails is increased, gradually bringing it to half an hour. The substance is washed off with warm water and baby soap, after which the skin is lubricated with cream or ointment. The course of treatment is at least 2 weeks.

• Homeopathy for psoriasis is quite effective drugs that successfully eliminate the manifestations of the disease. How does this treatment differ from other methods? Homeopathic remedies can affect tissue and cellular processes, with virtually no side effects, without causing addiction or dependence.

Names of drugs	Method of administration and dosage	Side effects	Special instructions
Psorinocheel	The standard dose for psoriasis in adult patients is 10 drops under the tongue.	None.	Can be prescribed during pregnancy and lactation, as well as in pediatrics.
Psoriaten	The ointment is applied in a thin layer three times a day for a month.	Redness of the skin, itching, allergies.	Not for use in children under 1 year of age.
Aesculus	Take 10 drops orally 3 times a day before meals, under the tongue. The average course of therapy is 1-1.5 months.	Sometimes – dyspeptic disorders, sleep disorders.	It is not used in pediatric practice or for immunosuppressive diseases (AIDS, tuberculosis, malignant tumors, collagenoses).
Ledum	Apply to affected areas twice daily.	Allergic manifestations.	None.
Sulfur-heel	Lubricate nails and skin once a day, at night. Duration of therapy is 10 days.	May cause a temporary increase in symptoms, which is not an indication to discontinue the drug.	Do not use if there is a tendency to suppuration or wet wounds.

Homeopathic preparations are not toxic. As practice shows, in some cases such treatment can exceed the effectiveness of most non-hormonal antipsoriatic medications.

• Surgical treatment is used for severe nail damage when other types of therapy do not bring the expected result. Nail removal is performed on an outpatient basis, using local anesthesia.

Prevention

Sometimes, for example, with a hereditary tendency to psoriasis, it is necessary to resort to preventive measures in order to reduce the risk of the disease. In this case, it is necessary to follow these rules:

• at least once a year, practice sea bathing. If this is not possible, baths with sea salt also help, which should be taken in courses of 10-14 days;
• you need to review your diet and limit certain foods, such as sweets, smoked foods, salty and fatty foods, and alcoholic beverages. It is preferable to add plant foods, dairy products, cereals, and seafood to your diet;
• Additionally, 1-2 times a year, it is advisable to take a preventive course of multivitamin and mineral complexes;
• it is necessary to promptly treat any diseases in the body, especially those of infectious origin;
• It is important to observe personal hygiene rules and wear protective gloves during any work. This will protect the skin and nails from the effects of negative mechanical and chemical factors.

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Forecast

Psoriasis is a disease that is constantly progressing. The use of external and internal medications can only stop the process and alleviate the symptoms, but, unfortunately, it is impossible to completely cure the disease.

Nail psoriasis and military ID

Many patients of draft age are interested in whether they will be taken into the army with a diagnosis of nail psoriasis?

By law, psoriasis is considered a chronic disease incompatible with military service, as it can become generalized with damage to the skin and joints. As a rule, patients receive category B upon passing a medical examination (which is written in the military ID), which guarantees an indefinite deferment from military service.

However, in wartime such a deferment may be cancelled and the person will be called up into the armed forces.

If nail psoriasis is not treated at all, the sick person may become disabled.

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