Psoriatic arthritis is a type of arthritis that develops in people who have psoriasis. PsA is an inflammatory condition that causes joint pain, stiffness, and swelling.
Most people develop psoriasis symptoms on their skin before they develop signs of PsA, though others notice arthritis symptoms first.
People with PsA often have symptoms that affect their nails. In fact, fingernail psoriasis is sometimes an early sign of PsA. About 80 percent of people with PsA have nail lesions.
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What Are the Signs and Symptoms?
PsA can cause a combination of nail issues. Not everyone with PsA experiences nail problems. Others may have only one or two nail changes.
Pitting
Many people with PsA have nail psoriasis, which can result in pitting. Pitting causes your nails to look like they have small holes or dents in them. Your nails might also feel rough or bumpy to the touch.
Pitting happens when cell growth causes a buildup of residues on your nail. When these residues fall off, they leave holes and dents.
Your nail will grow around these areas.
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Separation
PsA can cause your nail to separate from the nail bed. Nail separation may occur in small pockets or across your entire nail. When a small nail area lifts up off the nail bed, it may look clear or white.
Nail separation occurs due to inflammation in the nail bed.
White spots
PsA can also cause white spots on your nail. These white spots tend to appear in the middle of your nail.
White spots suggest that you have psoriatic lesions where new nail cells are made.
Discoloration
PsA can cause nail discoloration. This discoloration may cause your nails to look oil-stained. The discoloration may have a pink or purple tint.
The discoloration is caused by a buildup of cellular waste beneath your nail.
Red spots
Another sign of PsA occurs in the whitish half-moon near the base of your nail.
Some people with PsA develop red spots in this area.
These red spots may indicate the development of new blood vessels.
Crumbling or flaking
People with PsA may have nails that appear to be:
- Crinkling up
- Crumbling
- Flaking off layer by layer
The nail's crumbling and flaking can happen because of inflammation or too many skin cells in your nail bed.
Ridges
People with PsA sometimes develop vertical ridges running up and down their nails. These look and feel like raised lines.
Splitting with purple spots
Splitting often goes hand in hand with ridges. Your nail may split vertically along one of the ridgelines.
If there's a dark spot in the ridge, it could be a sign of bleeding that occurs when blood vessels break and leak into small splits in the nail.
Infections
Splitting and crumbling can leave your nails powerless against bacteria and fungi.
This can lead to nail infection and nail fungus.
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How Are PsA-Related Nail Problems Treated?
PsA-related nail issues usually respond well to general PsA therapies, notably oral medications utilized to reduce inflammation and protect your joints from damage.
Common medications for PsA include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs help diminish inflammation and treat pain. This category of medication includes ibuprofen (Advil, Motrin) and naproxen (Aleve).
- Biologic agents. Biologics are a newer generation of arthritis drugs developed through genetic engineering. They target inflammation in your body.
Some remedies work to target your nails directly, such as:
- Cortisone injections. Cortisone injections usually target inflammation in a single joint. Still, they can also be injected into the nail bed to reduce inflammation and fight psoriatic lesions.
- Steroid cream. Your doctor can prescribe a steroid cream to rub directly on your nails.
- Light therapy. Light therapy uses ultraviolet light to target psoriasis by slowing skin cell growth. Light therapy can be performed at home with special supplies or at your doctor's office.
- Antifungal medications. If you develop a fungal nail infection, your doctor might prescribe a topical antifungal cream.
- Antibiotics. If you have a bacterial infection in your nail, you may need oral antibiotics.
