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What is Psoriasis?
Psoriasis is a chronic, genetic,
noncontagious skin disorder that appears in many different forms and can affect any part of the body, including the nails and scalp. Psoriasis is categorized as mild, moderate, or severe, depending on the percentage of body surface involved and the impact on the patient's quality of life
(QoL). Psoriasis may be one of several types:
plaque psoriasis,
pustular
psoriasis, erythrodermic
psoriasis, guttate psoriasis or
inverse psoriasis. A dermatologist can help you to determine what type of psoriasis you may have.
Types of Psoriasis
Although psoriasis may affect any area of the body, it is most commonly found on the scalp, elbows, knees, hands, feet, and genitals.
Plaque psoriasis, the most common type of the disease, is characterized by raised, thickened patches of red skin covered with silvery-white
scales. Other types of psoriasis are characterized by different signs and symptoms. For example,
pustular psoriasis is characterized by pus-like blisters,
erythrodermic psoriasis is characterized by intense redness and swelling of a large part of the skin surface,
guttate psoriasis is characterized by small, drop-like
lesions, and
inverse psoriasis is characterized by smooth red
lesions in the folds of the skin.
Although psoriasis may be almost unnoticeable in its early stages, patients often report an itching and/or burning sensation as the disease progresses. In particular,
plaque psoriasis usually begins with small red bumps on the skin that progress to bigger, scaly patches that may become itchy and uncomfortable. As the
scales accumulate, pink to deep red
plaques with a white crust of silvery
scales appear on the skin surface. The pictures below depict various types of psoriasis.
Psoriasis
Plaque Psoriasis
Psoriasis |
Psoriasis |
Guttate Psoriasis |
Pustular Psoriasis |
Pustular Psoriasis |
The Psoriatic Nail
About 50 percent of persons with active
psoriasis have psoriatic changes in fingernails and/or toenails. In some
instances psoriasis may occur only in the nails and nowhere else on the
body. Psoriatic changes in nails range from mild to severe, generally
reflecting the extent of psoriatic involvement of the nail plate, nail
matrix (tissue from which the nail grows), nail bed (tissue under the
nail), and skin at the base of the nail. Damage to the nail bed by the
pustular
type of psoriasis can result in loss of the nail.
Nail changes in psoriasis fall into
general categories that may occur singly or all together:
- The nail plate is deeply pitted,
probably due to defects in nail growth caused by psoriasis.
- The nail has a yellow to yellow-pink
discoloration, probably due to psoriatic involvement of the nail
bed.
- White areas appear under the nail
plate. These are air bubbles marking spots where the nail plate is
becoming detached from the nail bed (onycholysis). There may be
reddened skin around the nail.
- The nail plate crumbles in yellowish
patches (onychodystrophy), probably due to psoriatic involvement in
the nail matrix.
- The nail is entirely lost due to
psoriatic involvement of the nail matrix and nail bed.
The following four photos illustrate
psoriatic changes in nails:
Psoriasis of fingernails.
Psoriasis of fingernails.
Onycholysis in psoriatic fingernails.
Pustular psoriasis on toenails and foot.
(Photos used with
permission of the American Academy of Dermatology
National Library of Dermatologic Teaching Slides and the Sulzberger
Institute for Dermatologic Education)
Psoriasis of the nails can resemble other
conditions such as chronic infection or inflammation of the nail bed or
nail fold. Psoriasis of the toenails can resemble chronic fungal
infection of the nails.
A person with psoriatic nails should
avoid any injury—bumps, scrapes, etc.—that may trigger a worsening
of psoriasis (Koebner’s phenomenon).
Nail psoriasis is treated by the dermatologist as part of the overall
treatment of the disease.
Nail psoriasis is frequently associated
with psoriatic arthritis.
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