Struggling with nail psoriasis? Here are the best treatment options

Nail psoriasis can be both frustrating and uncomfortable. It not only affects how your nails look but can also make simple tasks like buttoning clothes or typing painful. The good news is that effective treatments are available to reduce nail changes and restore nail health over time.

Doctify helps patients find verified dermatologists who specialise in psoriasis management and can create a treatment plan that is safe, practical, and tailored to your specific needs.

Understanding Nail Psoriasis

Nail psoriasis is a chronic inflammatory condition that affects the nail bed or nail matrix, the area where new nail growth begins. It occurs when the same overactive immune response that causes psoriasis also disrupts normal nail formation.

While it often appears alongside skin psoriasis, some people develop nail changes without visible skin plaques. It can affect fingernails, toenails, or both, and the severity can vary from mild surface changes to more advanced thickening or separation.

Common symptoms and nail changes

Nail psoriasis can appear in several ways, and symptoms may change over time. Common signs include:

• Pitting: small dents or holes on the surface of the nail
• Onycholysis: separation of the nail from the nail bed
• Discolouration: yellow or brown patches beneath the nail
• Thickened or crumbly nails that may be difficult to trim
• Tenderness or discomfort, especially when pressing on or walking with affected toenails

Although these symptoms can be distressing, consistent treatment and proper care can lead to noticeable improvement.

Why nail psoriasis happens

Nail psoriasis occurs when the immune system triggers inflammation in the tissues that produce the nail. This inflammation affects how the nail grows and attaches to the nail bed.

Several factors can contribute to this process, including:

• Genetic predisposition
• Presence of psoriatic arthritis or widespread skin psoriasis
• Environmental triggers such as stress, injury, or infection

Understanding what may be aggravating your psoriasis helps you and your dermatologist target both the symptoms and their underlying causes.

Diagnosing nail psoriasis

A dermatologist can often diagnose nail psoriasis based on your nail appearance and medical history. In some cases, they may recommend a nail biopsy to confirm the diagnosis and rule out fungal infection, which can sometimes look similar.

Early diagnosis is important because it allows treatment to start before permanent nail damage occurs.

Treatment options for nail psoriasis

Topical Treatments (for Mild Disease)

For mild nail psoriasis, topical corticosteroid creams or nail lacquers are often the first choice. These reduce inflammation and help slow down the overproduction of nail cells.

Vitamin D analogues such as calcipotriol can promote healthy nail growth, while tazarotene gel may help with thickened or discoloured nails. Results depend on regular, careful application and patience, as nail growth is slow.

Intralesional Therapy

For localised, stubborn nail psoriasis, small steroid injections can be given directly into the nail matrix. This procedure is performed by dermatologists under local anaesthetic and can be highly effective when topical treatments are not enough.

Systemic Medications (for Severe or Widespread Disease)

When nail psoriasis is extensive or affects daily life, systemic medications such as methotrexate, cyclosporine, or acitretin may be prescribed.

Modern biologic therapies including adalimumab, ustekinumab, and secukinumab target specific immune pathways and can dramatically improve both skin and nail symptoms. Your dermatologist will discuss these options if nail psoriasis is causing significant discomfort or cosmetic concern.

Combination Approaches

In many cases, combining treatments gives the best outcome. Topical therapies can be paired with phototherapy or systemic medication for faster and longer-lasting results. Regular nail care, such as gentle trimming and avoiding trauma, also helps reduce flare-ups and improve treatment response.

Home and nail care tips

Good nail care supports medical treatment and reduces the chance of worsening symptoms. Try to:

• Keep nails short and filed to prevent lifting or snagging
• Avoid biting or picking at the nails or cuticles
• Wear gloves during cleaning or household tasks
• Moisturise nails and cuticles daily using fragrance-free creams
• Avoid acrylic or gel manicures while undergoing treatment

These small habits can prevent further irritation and protect healing nails.

Managing emotional and practical impacts

Nail psoriasis can affect confidence and self-esteem, especially if the nails look visibly different. It may also make certain tasks or social situations uncomfortable.

Support groups, online communities, and counselling can help you cope with the emotional side of the condition. Regular follow-ups with your dermatologist will also help you track progress, celebrate improvements, and adjust treatments safely.

When to See a Dermatologist

You should book an appointment if your nail symptoms persist despite home care, if you develop pain, swelling, or signs of infection, or if several nails are affected.

A dermatologist can confirm the diagnosis, rule out fungal infection, and recommend advanced therapies such as biologic treatment or combination care. You can easily find verified specialists experienced in psoriasis and nail disorders through Doctify.

Conclusion

Nail psoriasis can be stubborn, but modern treatments offer real and visible improvement. With professional guidance, consistent care, and a tailored treatment plan, you can restore both the comfort and appearance of your nails.

If you are struggling with nail psoriasis, use Doctify to book an appointment with a trusted dermatologist who can help you find the best treatment approach for lasting results.

Find the best dermatologists in the United Kingdom, or search for trusted experts globally:

• Dermatologists in Ireland
• Dermatologists in Australia
• Dermatologists in the United Arab Emirates
• Dermatologists in Germany

Medically Reviewed
Last reviewed on 09/11/2025