Psoriatic arthritis nail changes are one of many frustrating aspects of the autoimmune disorder. Psoriatic arthritis commonly causes pain in places like your fingers, toes, wrists, knees, ankles, or lower back, according to the Mayo Clinic. However, people with psoriatic arthritis frequently develop nail psoriasis, too, which may lead to discomfort and interfere with your ability to do daily tasks, like open a container. In fact, up to 80% of people with psoriatic arthritis have nail lesions, according to a 2017 paper published in Reumatologia.
So why is this important? You may be able look to your nails for some insight into your psoriatic arthritis. “Noticing nail changes in the setting of psoriatic arthritis can be an indicator that your psoriasis is progressing within your body, creating inflammation in various parts of the nail structure and hands,” Scott Paviol, M.D, a board-certified dermatologist in Charlotte, North Carolina, tells SELF.
Below are six nail changes that commonly occur with psoriatic arthritis as well as tips to help you care for your nails.
1. You see grooves in your nails.
Nail pitting is the most common nail symptom associated with psoriatic arthritis. Pits are small indentations that may look like pricks from a small needle, the Mayo Clinic explains. “This is caused by inflammation in the nail matrix,” Dr. Paviol says. The nail matrix is the root of your nail, and when it’s inflamed, you may notice several other symptoms along with nail pitting, according to Marisa Garshick, M.D., a New York City–based board-certified dermatologist. “If the entire nail matrix is involved, the nail can appear brittle, crumbly, and whitish,” she tells SELF. A topical retinoid can help clear up pitting, but your treatment may vary depending on your unique symptoms, according to the American Academy of Dermatology Association (AAD).
2. Your nails are discolored.
You’ll also want to watch out for oil drops, which are irregular yellow-brown patches visible through the nail plate, says Dr. Garshick. Sometimes, the spots are called salmon patches, because of their coloring. You can identify these by looking for a yellowish-brown spot nestled between a white oily patch and the pink part of your nail. It may be possible to treat mild cases with a topical retinoid, but you might need a combination of oral medication and ultraviolet radiation therapy if your nail psoriasis has progressed, according to the AAD.
3.Your fingernail separates from your nail bed.
This condition, called onycholysis, happens when your fingernail becomes loose and separates from your nail bed, explains Dr. Garshick. Generally, the nail separates starting at the tip and travels down to where your nail meets the skin. In severe cases, people can lose their entire nail. The space created by this separation can lead to an infection, which we’ll get to next. Furthermore, you might notice the separated part of your nail looks opaque and has a white, yellow, or green tinge, according to the Mayo Clinic. Onycholysis treatment includes topical retinoids, steroid injections, or a combination of oral medication and ultraviolet radiation therapy, according to the AAD.
4. You have swollen, reddened skin around your nails.
Sometimes people with psoriatic arthritis develop a skin infection around their nails called paronychia, explains Dr. Garshick. This can happen when your nail separates from the bed, when your nails are cracked, or when you have broken skin that allows bacteria, dirt, or other organisms in the cut, according to the Cleveland Clinic. With paronychia, the skin around one or more of your fingernails may suddenly be swollen, reddened, and painful. Paronychia typically requires medical attention; treatment depends on the severity of your infection but could include antibiotics, according to the Cleveland Clinic.
5. Your nails have white spots.
Many people get white spots on their nails, a condition called leukonychia. Sometimes, these are caused by injury or from biting or picking your nails, meaning white spots alone don’t necessarily mean your psoriasis is progressing. However, leukonychia can be a sign of psoriatic nails, particularly if you also notice some of these other changes, like pitting. The best way to treat leukonychia is generally managing its underlying cause.
6. Your nails always break.
Weak nails are another classic symptom of psoriatic arthritis, according to Norman Gaylis, M.D., a rheumatologist in Miami. “The telltale signs of psoriatic arthritis include a change in the texture of the nails; they are often more brittle and break,” Dr. Gaylis says. Having brittle nails doesn’t necessarily mean that you have also developed nail psoriasis, but it is worth watching for if you have psoriatic arthritis. It’s a good idea to protect weak nails by wearing gloves whenever you’re participating in activities where they could break.
How to treat and care for psoriatic arthritis nails
It’s best to err on the side of caution and consult with your physician if you’re at all worried about your nails, Dr. Garshick says. “For any individual who has psoriatic arthritis and is experiencing any nail changes, it is always a good idea to talk with your doctor, since it can be important to determine if it is related to psoriasis or not,” Dr. Garschick says.
Dr. Paviol suggests tracking your nail changes (including in your nail’s shape, color, and texture) and how long they’ve been happening in a journal. It can be helpful to make notes of other psoriatic arthritis–related changes, such as new joint symptoms and any skin lesions. If you experience any of these nail changes and joint pain (particularly in new areas), then you may want to talk to your dermatologist or rheumatologist if you have one. (Of course, it’s understandable if you’re worried about scheduling a doctor’s appointment during the pandemic. Many physicians offer telehealth sessions, and you can even send a photo of your nails ahead of your appointment. Here’s more about getting medical care during COVID-19).