5 Ways Psoriatic Arthritis Changes Your Nails and How to Manage It

Psoriatic arthritis (PsA) is a chronic inflammatory condition that affects both the skin and joints, often leading to a range of symptoms that can be painful and debilitating. Among the many manifestations of PsA, nail changes are particularly common and can be quite distressing for patients. Understanding how PsA affects the nails and what can be done to manage these changes is crucial for maintaining both physical and emotional well-being.

Understanding Psoriatic Arthritis

Before delving into the specific ways PsA can change your nails, it is essential to understand the condition itself. PsA is an autoimmune disease, meaning the body's immune system mistakenly attacks its tissues, leading to inflammation. This inflammation primarily affects the joints and skin but can also involve other organs and tissues, including the nails.

PsA is often associated with psoriasis, a skin condition characterized by red, scaly patches. However, not everyone with psoriasis develops PsA, and vice versa. The exact cause of PsA is unknown, but a combination of genetic, environmental, and immune factors is believed to play a role.

How Psoriatic Arthritis Affects Nails

Nail changes occur in up to 80% of individuals with PsA, making it a significant aspect of the disease. These changes can range from mild to severe and may involve one or multiple nails. Here are the five most common ways PsA can alter your nails and what you can do about it:

1. Pitting

Description: Nail pitting is one of the hallmark features of PsA, characterized by small, depressions or pits on the nail surface. These pits are caused by the loss of cells from the nail's surface layer.

Impact: Pitting can affect the appearance and texture of the nails, making them look uneven and unsightly. It can also make the nails more prone to damage and infection.

Management:

Moisturizing: Regularly moisturizing your nails and cuticles can help improve their overall health and reduce the severity of pitting.

Topical Treatments: Prescription topical treatments, such as corticosteroids or vitamin D analogs, can help reduce inflammation and promote healthier nail growth.

Nail Care: Gentle nail care practices, such as avoiding harsh chemicals and keeping nails trimmed, can prevent further damage.

2. Onycholysis

Description: Onycholysis refers to the separation of the nail from the nail bed, starting at the tip and progressing towards the cuticle. This can create a gap between the nail and the skin underneath, which may become filled with debris and cause discoloration.

Impact: Onycholysis can be painful and may lead to secondary infections if dirt and bacteria accumulate in the gap. It can also make the nail more susceptible to trauma.

Management:

Avoiding Trauma: Protect your nails from injury by wearing gloves during activities that may cause trauma.

Keeping Nails Dry: Ensure your nails are kept dry, as moisture can worsen onycholysis.

Medical Treatments: In severe cases, your doctor may recommend treatments such as antifungal medications or corticosteroid injections.

3. Subungual Hyperkeratosis

Description: Subungual hyperkeratosis involves the thickening of the skin under the nail, leading to a buildup of keratin. This can cause the nail to appear raised and thickened, and may be accompanied by pain and discomfort.

Impact: Thickened nails can be difficult to trim and may cause pain when pressure is applied, such as when wearing shoes.

Management:

Regular Trimming: Trim your nails regularly to keep them short and reduce the risk of discomfort.

Soaking and Filing: Soak your nails in warm water to soften them before trimming, and use a nail file to smooth the edges.

Medical Treatments: Topical treatments, such as salicylic acid or urea creams, can help reduce the thickness of the nails. In some cases, your doctor may recommend systemic medications to manage underlying PsA.

4. Nail Discoloration

Description: Nail discoloration is common in PsA and can manifest as yellow, brown, or white patches on the nails. This discoloration is often due to subungual hyperkeratosis or onycholysis.

Impact: Discolored nails can be a cosmetic concern and may also indicate underlying nail damage or infection.

Management:

Good Hygiene: Maintain good nail hygiene by keeping your nails clean and dry.

Topical Treatments: Medicated nail lacquers containing antifungal or antibacterial agents can help treat underlying infections.

Avoiding Staining Agents: Limit exposure to substances that can stain the nails, such as nail polish and harsh chemicals.

5. Beau's Lines

Description: Beau's lines are horizontal grooves or indentations that run across the nail. These lines are a sign of disrupted nail growth, often caused by severe flare-ups of PsA.

Impact: Beau's lines can indicate periods of intense inflammation and may be accompanied by other nail changes.

Management:

Managing PsA Flares: Effective management of PsA flare-ups can help reduce the occurrence of Beau's lines. This may involve adjusting your medication regimen under the guidance of your doctor.

Nutritional Support: Ensure you are getting adequate nutrition, as deficiencies can impact nail health.

Medical Consultation: If Beau's lines are recurrent or severe, consult with your healthcare provider for a comprehensive evaluation and management plan.

General Nail Care Tips for Psoriatic Arthritis

In addition to the specific management strategies for each type of nail change, there are general nail care tips that can help maintain overall nail health:

Keep Nails Short: Trim your nails regularly to reduce the risk of trauma and infection.

Avoid Nail Trauma: Protect your nails from injury by wearing gloves during activities that may cause damage.

Moisturize Regularly: Apply moisturizing creams or oils to your nails and cuticles to keep them hydrated.

Avoid Harsh Chemicals: Limit exposure to harsh chemicals, such as acetone-based nail polish removers and cleaning agents.

Consult a Dermatologist: Regular check-ups with a dermatologist can help monitor nail health and manage PsA effectively.

Conclusion

Nail changes are a common and often distressing aspect of psoriatic arthritis. Understanding the ways PsA can affect your nails and implementing appropriate management strategies can help improve nail health and overall quality of life. By working closely with your healthcare provider and adopting good nail care practices, you can mitigate the impact of PsA on your nails and maintain healthier, more resilient nails.