Psoriasis of the nails

Psoriasis of the skin - this is a fairly well-known and common disease, which is accompanied by a violation of normal cell division. However, not many know that there is another similar pathology affecting the nail plate - this is psoriasis of the nails. The disease has much in common with ordinary psoriasis and is characterized by layering the cells against each other. Thus, the so-called psoriatic plaques are formed.

[1], [2], [3], [4],

Causes of the psoriasis of the nails

Psoriasis of the nails is diagnosed relatively rarely and, as a rule, accompanies other varieties of psoriasis: for example, psoriatic lesions of the skin or joints. Occasionally, psoriasis of the nails is an independent disease.

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

[5], [6], [7], [8]

Risk factors

The risk factors that can affect the onset of psoriasis of the nails are identified:

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

[9], [10], [11], [12], [13]

Pathogenesis

The pathogenesis of psoriasis of the nails consists in the disorder of proliferation and differentiation of cells.

1. There is a shortening of the cell cycle.
2. An excessively large number of cells is formed.
3. Appearances and thickening appear on the nail plate.

It is generally accepted that psoriasis is a polyethiologic disease. 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 total prevalence of psoriasis on the planet is about 3%. The disease is not contagious and does not pose a danger to others.

[14], [15], [16], [17],

Symptoms of the psoriasis of the nails

The clinical symptoms of psoriasis of the nails are manifold, but there are also characteristic signs by which the disease can be determined.

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

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

Under the nail gradually formed emptiness, where eventually accumulates dirt, particles of the epithelium, etc. Because of this, the nail becomes dirty white, sometimes there is an unpleasant odor.

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

The last characteristic sign of psoriatic lesion is trachionomychia - the opacity and roughness of the nail plate, which becomes flat and even slightly concave.

Psoriasis of nails in children is rare, in about 15% of all cases of childhood psoriasis. Symptoms of the disease often precede skin manifestations of psoriasis, which can be detected even a few years after the nail symptoms.

Forms

As we said above, psoriasis of nails has several successive stages of flow:

• I stage - a symptom of a "thimble";
• II stage - stage of onycholysis;
• III stage - hemorrhagic;
• IV stage - trachionichia.

In addition, isolated and individual types of psoriasis of the nails.

• Thimax psoriasis is the most frequent manifestation of the disease, which is characterized by the predominance of such a symptom as a thimble symptom: a scattering of tiny cavities on the nail surface.
• Full or partial onycholysis is the predominance of painless detachment of the nail plate.
• The central, distal or lateral form of onycholysis is a painless, directed detachment of the nail.
• Onyhomadez - rapid detachment of the nail.
• The psoriatic form of paronychia is a sign accompanying the generalized course of psoriasis. It is characterized by inflammation and compaction of the cuticle and skin near the nail.

[18], [19], [20], [21]

Complications and consequences

Psoriasis of nails is a disease that can not be cured completely. Often, patients manage to get the symptoms subsided, which eventually appear again.

Psoriatic nail lesions usually precede or occur against the background of a common form of psoriasis, so one of the complications can be atherosclerotic vascular changes and diseases of the cardiovascular system.

Sometimes the result of psoriasis can be psychological problems associated with the rejection of the surrounding patient. Often, to get away from the problem, patients unconsciously acquire new pathologies: alcoholism, depressive states, neuroses. Serious disturbances of the psyche can turn into diseases of the heart and endocrine system, development of oncological diseases.

Prolonged psoriasis can visually change the nails and skin of a person, which negatively affects its social adaptation. Such people often become withdrawn, secretive, lead an isolated way of life.

[22], [23], [24]

Diagnostics of the psoriasis of the nails

Typically, a dermatologist in appearance can identify and diagnose nail psoriasis. In some cases it is necessary to resort to additional studies that help put the "last point" in the diagnosis. As a rule, to begin with, the doctor prescribes tests:

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

Instrumental diagnosis, as a rule, is not carried out.

[25], [26]

Differential diagnosis

Differential diagnosis is one of the main points of diagnosis. So, psoriasis of nails in some cases can be taken for paronychia and onychia of fungal or microbial etiology, or for dystrophic changes of the nail. Especially often they confuse psoriasis and fungal lesions of nail plates. There is a logical question: how to distinguish a nail fungus from psoriasis of nails?

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

Diagnosis becomes more complicated if the patient is diagnosed with psoriasis and gets a positive sowing of the fungal infection at the same time.

[27], [28], [29]

Treatment of the psoriasis of the nails

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

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

• it is always necessary to shorten the nails shortly;
• It is unacceptable to resort to pruning cuticles, to manicure and pedicure procedures on the affected nails. It is necessary to remember once and for all: manicure with psoriasis of nails, as well as nail extensions with psoriasis can not be carried out;
• hangnails should be removed with fine-grained manicure files, which will allow the nails to look neater;
• to prevent infection, it is recommended to cover the nail plates with a special lacquer;
• any work should preferably be carried out in protective gloves;
• with psoriasis of the nails of the lower extremities, it is preferable to wear the shoes a bit larger in size to prevent the fingers from squeezing;
• Regularly apply appropriate ointments or creams to nourish and moisturize your fingers and nails.

The treatment of psoriasis is always combined, since it is not advisable to use any one remedy: an integrated approach is necessary. It is important to treat chronic and other diseases in a timely manner, to maintain the immune forces and the nervous system.

• Treatment of psoriasis of nails at home is possible, but requires some effort and patience. In order to gain control over the disease, experts advise adhering to such rules:
  • To observe a diet or to accept preparations with the big maintenance of a calcium;
  • with discomfort and itching to take antihistamines (for example, suprastin, diazolin, etc.);
  • observe the rules of personal hygiene, wash nails infusion of medicinal herbs (St. John's wort, sage);
  • daily lubricate affected areas with vegetable oils;
  • maintain immunity, periodically take multivitamin complexes;
  • the main treatment should be done only under the supervision of a doctor.

In addition, you can use the recipes of alternative medicine and other types of treatment, which we will discuss further.

• Healing varnishes for psoriasis of nails:
  • Nail Tek Xtra - a remedy for too weak and thin nails;
  • Blaze Nail Force - a varnish for intensive strengthening of nail plates;
  • Nail Tek II Intensive Therapy - a means for thinned and exfoliating nails.

Experts argue that the usual curative effect has a usual colorless varnish: it protects the affected areas from infection, and also makes the nail plate glossy and more attractive.

• Medicines for psoriasis of the nails are appointed individually, since the manifestations and severity of the pathology in patients may be different. For treatment, various groups of drugs are used, which the doctor prescribes.

	Dosing and Administration	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 lesions, with syphilis and tuberculosis of the skin.
Triamcinolone	Ointment is applied up to 3 times a day.	Edema, rashes.	Do not prescribe during pregnancy, as well as with viral and fungal skin diseases.
Prednisolone	Apply a small layer up to 3 times a day. Duration of therapy - up to 2 weeks.	Feeling of itching, burning, development of folliculitis.	It is not recommended to apply to large areas of the skin.
Ointment for psoriasis of nails
Lorinden	Apply 2 times a day, for no more than 2 weeks.	Dryness of the skin, itching.	Do not use in the first trimester of pregnancy and in young 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. The duration of treatment is determined individually.	With prolonged use, skin irritation is possible.	Can be used in pediatric practice.
Cream for psoriasis of nails
Pikladol	Apply up to 3 times a day. Duration of therapy is 3 months.	Not observed.	None.
Sophora	Rubbing up to 4 times a day every day for one month.	None.	None.
Psoril	Apply up to 3 times a day without rubbing.	Allergic manifestations.	Do not use to treat children.
Proskutan (Psorkutan)	Proskutan with psoriasis of the nails is used 2 times a day. The course of treatment can be long, from 2 to 12 months.	Dryness, skin irritation, allergy, hyperpigmentation.	It is not prescribed for pregnancy and lactation, as well as for psoriatic lesions of more than 30% of the body surface.
Dermatotropin preparations for psoriasis of nails
Anthralin	Apply a thin layer, avoiding healthy skin areas, once a day. The course of therapy - 1,5-2 months.	Allergy, puffiness, skin irritation.	Ointment is washed off only with warm water without the addition of detergents.
Mikanol	Apply to affected areas of the skin 1-2 times a day.	Allergies and pigmentation of nearby healthy skin.	Protective gloves are used during application.
Dithranol	Use once a day.	Changes in the structure of surrounding healthy skin.	Not used in pediatrics.
Retinoid preparations for psoriasis of nails
Tretinoin	Apply twice a day on clean skin.	Allergic reactions.	Not applicable in pregnancy and lactation.
Tazaroten	Apply a thin layer overnight.	Feeling of itching and burning, hyperemia.	Do not apply to open wound surfaces.
Benzoyl peroxide	Use 1-2 times a day, mainly at night.	Dry skin, irritation.	Has a whitening effect.

• Vitamins are a necessary supplement to the overall treatment of nail psoriasis. This should be remembered when choosing mineral-vitamin preparations, and when drawing up a diet for psoriasis. We present to your attention a list of vitamins, whose presence will greatly facilitate the course of the disease.

1. Vitamin A - helps to eliminate inflammatory changes in the skin. They are rich in products such as bell pepper, cream, sour cream, liver.
2. Vitamins gr. B - normalize the work of the nervous system, promote the flow of cellular metabolism. Contain in buckwheat, nuts, liver.
3. Ascorbic acid - supports immunity, strengthens capillaries. Vitamin C is contained in rose hips, berries, kiwi, citrus fruits.
4. Vitamin D is a universal dermatological agent. The source of the vitamin is ultraviolet rays.
5. Vitamin E is an antioxidant that removes inflammation and allergies. In sufficient quantity it is contained in practically any unrefined vegetable oil.

If there is a need to take complex vitamins for psoriasis of the nails, you can choose one of the following drugs:

• Vitrum Beauty - specially created complex for support and improvement of health of nails, skin, hair. With psoriasis take 1 tablet three times a day.
• Multitabs intensive - rich vitamin-mineral composition helps to support the body during stresses and stresses, replenishes the lack of vitamins and microelements. It is recommended to take 1 tablet a day, with food.
• Merz special dragee - a balanced complex, indispensable for the treatment of psoriasis. Recommended dosage is 1 pills per day.
• Centrum is a combined drug that normalizes the process of cell division. It serves the prevention of malignant tumors. Daily rate - 1 tablet.

Some patients use oily solutions of vitamins as an external remedy for psoriasis. Sometimes such an application is justified and has some therapeutic effect. For example, vitamin A externally with psoriasis of nails prevents the development of the inflammatory process, heals and strengthens tissues. The only condition: use the drug regularly, twice a day (morning and night), slightly wetting the affected surface. Do not rub the mortar!

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

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

Also in the treatment of psoriasis apply dynamometry, magnetotherapy, UHF, phonophoresis (with hormonal drugs), cold therapy.

• Alternative treatment of psoriasis of nails can be actively used at the initial stages of the disease:
  • Baths with the use of decoction on the laurel leaf. Pour 40 g of leaves into 1 liter of boiling water, boil for 10 minutes. Dip your hands or feet into a warm broth for a quarter of an hour. In addition, bay leaves from psoriasis of nails can be taken orally, 40 ml of prepared decoction three times a day;
  • compress of 0.5 liters of warm water, 2 tbsp. L. Oat flour and as much starch;
  • baths with the addition of gelatin. Soak 2 tsp. Gelatin in 200 ml of cool water, after which the solution is heated to body temperature and the affected fingers are lowered into it for a quarter of an hour. After the procedure, the fingers and nails are lubricated with cream or ointment.

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

Inside, you can take infusions of herbs, such as nettle, ayr, elecampane, St. John's wort, string, chamomile. They brew and drink like tea, during the day.

For the preparation of herbal baths most often used celandine. For 50 g of raw material take 2 liters of boiling water, keep under the lid for at least 1 hour. This infusion is no less effective for compresses.

Useful for psoriasis compress on the basis of cocklebur cocktail. 4 tbsp. L. Herbs are brewed in 0.5 liters of water and applied to the affected areas. Top covered with cellophane and a towel. Withstand 15 minutes. The procedure can be repeated on a daily basis.

A good effect is expected from the constant use of infusion on the basis of the herb St. John's wort, rhizome of calamus, celandine, string, cranberry leaves. 1 tsp. Pour 250 ml of boiling water. Take 50 ml twice a day.

It is very common to treat psoriasis on nails with birch tar. Affected place is smeared with tar once a day. The first procedure should last no more than 10 minutes. Further, the retention time of tar on the nails is increased, gradually bringing to half an hour. The substance is washed off with warm water with baby soap, then the skin is smeared with cream or ointment. The course of treatment - at least 2 weeks.

• Homeopathy with psoriasis is a fairly effective medication that successfully eliminates manifestations of the disease. What is the difference between such treatment and other methods? Homeopathic remedies can influence the tissue and cellular processes, with virtually no side effects, without causing addiction and dependence.

Names of preparations	Dosing and Administration	Side effects	Special instructions
Psorinocheel	The standard dose for psoriasis for adult patients is 10 drops under the tongue.	None.	Can be prescribed in pregnancy and lactation, as well as in pediatrics.
Psoriaten	Ointment is applied a thin layer three times a day for a month.	Redness of the skin, itching, allergies.	Not applicable in children under 1 year.
Escolus	Take 10 drops three times a day before meals, under the tongue. The average course of therapy is 1-1.5 months.	Sometimes - dyspeptic disorders, sleep disorders.	Do not use in children's practice and with immunosuppressive diseases (AIDS, tuberculosis, malignancies, collagenoses).
Ledum	Apply to affected areas twice a day.	Allergic manifestations.	None.
Sulfur-Heel	Lubricate the nails and skin once a day, at night. The duration of therapy is 10 days.	May cause a temporary increase in symptoms, which is not an indication to cancel the remedy.	Do not apply with a tendency to suppuration and wet wounds.

Homeopathic remedies are not toxic. As practice shows, in some cases such treatment may exceed the effectiveness of most non-hormonal antipsoriatic medicines.

• Operative 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 predisposition to psoriasis, one must resort to preventive measures in order to reduce the danger of the disease. In this case, you must follow these rules:

• at least once a year to practice sea bathing. If this is not possible, baths with sea salt also help, which should be taken for 10-14 days;
• you need to revise your diet and limit certain foods, such as sweets, smoked products, salted and fatty foods, spirits. It is preferable to add vegetarian food, sour-milk products, cereals and seafood to the ration;
• In addition, 1-2 times a year it is desirable to take a preventive course of multivitamin and mineral complexes;
• it is necessary to timely treat any diseases in the body, especially infectious genesis;
• it is important to follow the rules of personal hygiene, and during any work wear protective gloves. 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 medicines can only stop the process and alleviate the symptoms, but unfortunately, it is impossible to cure the disease completely.

Nail polish and military ticket

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

By law, psoriasis is considered a chronic disease incompatible with service in the army, as it is capable of generalization with the defeat of skin and joints. As a rule, patients on passage of a medical board receive a category B (that is registered in the military ticket), which guarantees an untimely delay from the army service.

Nevertheless, in time of war such a delay can be canceled and a person will be drafted into the ranks of the armed forces.

If the psoriasis of the nails can not be treated at all, the sick person can become disabled.

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