How to Heal Psoriasis of the Nail Bed
Nail bed psoriasis is a relatively common form of the skin disease that affects about 7.5 million Americans. Dermatologist Dr. Richard Langley estimates half of that number have nail bed psoriasis.Some may have nail bed psoriasis only--and no sign of the unsightly red lesions and silver scales of psoriasis. Nail bed psoriasis is more common on the fingers than toes, says Dr. Langley. But, like all forms of psoriasis, there is no cure (as of November 2009), only containment and control. Nail bed psoriasis is particularly hard to treat, he says.
Instructions
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Treatments
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Make sure it is nail bed psoriasis. Dr. Langley says it could be a fungal infection and physicians can misdiagnose the two conditions.They can make a correct diagnosis after analyzing nail clippings and making a fungal culture. If it is a fungal infection oral antifungals will be effective. But it could be both. The National Psoriasis Foundation (NPF) says about one third of nail bed psoriasis sufferers also have a fungal infection.
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Take a course of systemic drug treatment, either orally or injected. The medications and usually for moderate to severe psoriasis, says Dr. Langley. Methotrexate works very well on the more severe forms, because it reduces rapid turnover of skin cells and has an inflammatory effect on white blood cells, he says. Both methotrexate and the immune suppressant cyclosporine can be effective against nail bed psoriasis. If you already take a course of systemic drugs for psoriasis elsewhere on your body, you might also find an improvement in your nail bed psoriasis. Weigh up the risks compared with the benefits. Dr. Langley says if psoriasis only affects the nail bed, physicians will rarely use systemic medications. The risk of kidney damage from a high dose of methotrexate usually out weighs the benefits, he says.
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Practice containment. The NPF suggests trimming the nails back to the point of firm attachment, as short as possible. "Loose nails continue to be injured as they rub against surfaces. It is important to protect your nails from damage because trauma will often trigger or worsen nail psoriasis," says the NPF.
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Tips & Warnings
The most common form of nail bed psoriasis is pitting and shallow depressions or dents that look like pin holes--consult a dermatologist.
When the nail lifts away from the nail bed it is onycholycosis. The NPF says this is a fungal infection that thickens nails and may be present with nail psoriasis.
Lost nails will grow back slowly, says Dr. Langley, even in the most severe cases. Fingernails may take 6 to 12 months and toenails 12 to 18 months.
Treatments can go a long time before there is any noticeable improvement.
Topical treatments, whether steroid or not, are generally ineffective, says Dr. Langley
Injecting corticosteroids into the nail bed is very painful and not usually continued, says Dr. Langley.
