Psoriasis on Fingers and Nails: Symptoms, Causes, and Treatments

Psoriasis may prefer certain places–like your elbows and knees–but the inflammatory condition can show up anywhere on your body. And that includes fingers and nails. 

When it comes to psoriasis, there may not be one predictable pattern: “Hands and nails tend to go together, but they don’t always. Some people can have nail psoriasis without the disease anywhere else. Some people see it on the palms of their hands and soles of their feet, but not their nails,” says Rachel Day, MD, FAAD, Chief Medical Officer at Zest Dermatology.

Noticing red, scaly skin on fingers or concerning nail changes and wondering if these are signs of psoriasis? These may all indicate psoriasis symptoms on hands. Keep reading to learn more about psoriasis on fingers and psoriatic nail disease, including their causes, symptoms, diagnosis, and the best treatment options. 

Understanding psoriasis on fingers

Psoriasis is a systemic inflammatory condition that can affect the skin, nails, and joints. Commonly, psoriasis appears as thick, raised patches of skin that may be red and/or scaly. These areas can also be uncomfortable, too, causing itching and pain. Most often, you’ll find these plaques covering places like your elbows and knees and scalp, but the disease can affect any part of the body, Dr. Day says. And that includes your fingers.

You may notice crusting patches of skin on your fingers that can crack and bleed. These plaques can cause significant distress, too, making hand-heavy tasks like computer work, cooking, and cleaning difficult and painful. Itching can be distracting and incredibly uncomfortable. And given hands are constantly visible, psoriasis on your fingers may be a source of stress, shame, and anxiety. Know that there is good help available with the right diagnosis and treatment approach. 

Understanding psoriatic nail disease

Up to half of people with psoriasis also have psoriatic nail disease. Whether or not you have nail psoriasis is important to know–it’s linked to having more severe disease and is more common in people who also have joint symptoms like stiffness and swelling. 

Having nail psoriasis is associated with enthesitis–inflammation that occurs where tendons and ligaments meet bone—which is a sign of early psoriatic arthritis, according to research.

Psoriasis develops into psoriatic arthritis (PsA) in about 30% of patients, most often occurring 10 years after psoriasis starts, per the National Psoriasis Foundation. PsA is an autoimmune disease that affects both the skin and joints, and the majority of PsA patients experience nail changes too, according to one study. Addressing psoriatic arthritis nail symptoms with prompt treatment may also help slow or delay the disease’s development to PsA.

Unfortunately, nail psoriasis can affect your day-to-day function and comfort–and even your ability to work. Routine tasks are often difficult, including dressing yourself, this condition is linked to anxiety and depression, and the visibility of nail symptoms can also lead to self-image and self-esteem problems. All that to say: this disease is more than just an aesthetic concern, it can be a real detriment to your quality of life, which is why diagnosis and treatment can be so impactful in helping you do the things you have to do–and love to do–again.

Common Symptoms of Psoriasis on Fingers and Nails

Psoriasis affects skin and nails in different ways. Remember, you may see symptoms on your skin or nails–or both. 

Here are common symptoms on the skin, which can affect hands and fingers:

• Plaques that appear red with silvery, shiny scales.
• Patches of thick, raised skin can be small or large
• Scales may be painful, burn, or itch.
• Skin can crack or bleed.

Here’s how psoriasis may show up on the nails:

• Oil spots: Yellowing of the nail bed under the nail plate. These yellow fingernail spots can look like olive oil, Dr. Day says.
• Onycholysis: When the nail plate lifts from the nail bed. (You will notice air between the skin of your finger and the nail, Dr. Day describes.)
• Nail pitting: Appears as irregular holes in the nail plate.
• Splinter hemorrhages: Thin areas of bleeding under the nail that appear like little red lines down fingernails. 
• Subungual hyperkeratosis: A build-up of debris under the nail bed leading to crusty or crumbly nails.

In addition, psoriasis can also affect the joints (psoriatic arthritis). Symptoms include swelling, tenderness, and stiffness of joints.

Causes and triggers of psoriasis in the hands

Psoriasis is an autoimmune condition, meaning the body’s immune system mistakenly attacks its own tissues. Like all autoimmune conditions, the cause is believed to be two-fold: there is a combination of genetic predisposition and an environmental factor that triggers the disease to develop. One common trigger is smoking.

When it comes to nail psoriasis specifically, this manifestation often develops after psoriasis occurs on the skin.

Diagnosis and severity of psoriatic nail disease

Up to one in 10 of those with nail psoriasis don’t have any signs of the disease on their skin. That can make it really tough to understand exactly what’s going on with you if you’re noticing nail problems only. Plus,  there are several reasons why your nails might be crumbling, pitting, flaking, or discolored. Those reasons include:

• Infections from bacteria, fungi, or viruses
• Injuries (like wearing too-tight shoes)
• Internal diseases
• Medication side effects

Dermatologists diagnose psoriatic nail disease via a visual skin and nail exam, along with your health and family history. 

What’s more, they’re trained to understand the differences in how these symptoms present in psoriasis compared to other conditions. 

For example, says Dr. Day: “Pitting is irregular in psoriasis, which differs from other conditions where pitting appears in a pegboard pattern. It’s important to see a trained dermatology specialist because the diagnosis is through a visual evaluation.” 

Nail crusting or yellowing can also be confused with fungal infections and is often treated as such by non-dermatology specialists, says Dr. Day. 

If you have been diagnosed with a nail fungal infection but it’s not clearing up with treatment, she recommends getting a second opinion by a dermatology specialist or asking for the diagnosis to be revisited.

Best Treatment options for finger and nail psoriasis

The fortunate news is that there are many treatment options for psoriasis on fingers and nails. Treatment should always be individualized based on your symptoms, health history, comorbidities, lifestyle, preferences, and more.

 A dermatology specialist can help you develop the treatment plan that’s right for your skin and nail needs.

Treatments for psoriasis on fingers

To address psoriasis lesions on skin, here’s what your clinician might recommend:

• Topical treatments, including regular use of moisturizers, corticosteroids and vitamin D (calcipotriene), and other medicated creams and ointments.
• Systemic medications that target the immune system. A variety of prescription medications, like methotrexate and biologics, dampen an overactive immune system to help prevent the buildup of skin cells that create plaques, leading to clear skin. 
• Light therapy (phototherapy). Helps by slowing the growth of skin cells, dampening the immune system, and reducing inflammation.

Nail psoriasis treatments

Biologic medications, such as etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), secukinumab (Cosentyx), ixekizumbab (Taltz), guselkumab (Tremfya), and ustekinumab (Stelara), may be prescribed for adults who have moderate-severe disease that affects their nails, according to research.

For certain patients, medication injections into nails may also be recommended to help prevent and treat nail psoriasis, adds Dr. Day.

If psoriasis has led to discolored or disfigured nails, keep in mind that it can take time to see some real difference from treatments. 

Fingernails not affected by psoriasis take six months to grow out, while toenails take 12 to 18 months, Dr. Day says. With psoriasis, that timeline is longer. It may take four to six months to see new normal nail growth in just half of the nail.

Managing and preventing psoriasis flares on hands and nails

A flare-up is when symptoms get worse for a period of time. Anything that increases inflammation can trigger a psoriasis flare, such as:

• Excess alcohol intake
• Injury to the skin
• New medication
• Smoking
• Stress
• Sunburns
• Viral infection
• Weather (cold, dry air, indoor air conditioning)

Some of these factors are unavoidable, but there are things you can do to mitigate their impact on your skin and nails. 

For example, apply a good moisturizer to hands often to keep skin moisturized during weather changes, use a hand cream that contains an SPF to protect against the sun, and have stress-management strategies in place–good sleep, exercise, yoga/meditation, connection with loved ones–that you can use when things get tough. 

In addition, Dr. Day stresses avoiding injury to the skin and nails, when possible. Psoriasis is associated with what’s called the Koebner phenomenon, which is the appearance of new lesions on the skin as a response to skin trauma. “If there is damage to the skin, psoriasis can develop,” she explains. You can protect your fingers and hands by:

• Keeping nails short. Long nails can become easily snagged or pulled. “Keeping nails neat and short is helpful in psoriasis,” Dr. Day says. 
• Avoid getting professional manicures, including acrylic nails: These visits make nails look great, but they can add trauma to nails that trigger psoriasis. Dr. Day says that it’s okay to continue to paint your nails–the issue isn’t in the nail polish itself–but the problem is in how nails are prepped, especially when cuticles are pushed back. Keep things simple–it’s often easier and safer to paint your nails yourself. 
• The same goes for fingers, making sure that you protect them from cuts, scrapes, and burns. Of course, these injuries happen by accident but safe habits like using proper cutting techniques when preparing foods or wearing protective gloves when working with your hands or cleaning are all the more important.