How Do You Treat Toenail Psoriasis?

Psoriasis is a chronic autoimmune skin condition that can also involve the toenails and fingernails. Treatment for nail psoriasis usually involves topical treatments, corticosteroid injections, laser treatment, PUVA, methotrexate, retinoids, and others.

Psoriasis is a chronic autoimmune condition affecting the skin. Signs of psoriasis include skin that is red, thick, scaly, and flaky. About 50% of people who have psoriasis have nail involvement, though fingernails are more often involved than toenails.

Treatment for nail psoriasis usually involves the nail bed that supports the nail or the nail folds that tuck around the edges and may include:

• Treatment applied topically to the nails
  • For mild or early nail psoriasis
  • Because nails grow slowly, treatments need to be applied for several months
  • Nail psoriasis can be stubborn, so more than one treatment may be needed
    • Corticosteroids
    • Calcipotriol 
    • Tazarotene
• Stronger treatments
  • Injections of corticosteroids (or other psoriasis medicines)
  • Laser treatment
  • PUVA (psoralen plus exposure to UVA rays)
  • Systemic treatment for severe psoriasis and nail psoriasis
    • Biologics and biosimilars
      • Tumor necrosis factor-alpha (TNF-alpha) inhibitors 
      • Interleukin 12 and 23 (IL-12, IL-23) inhibitors 
      • Interleukin 17 (IL-17) inhibitors 
      • Interleukin 23 (IL-23) inhibitors 
      • T-cell inhibitors 
    • Methotrexate
    • Retinoids
    • Cyclosporine
    • Apremilast (Otezla)
• Treatment for nail infections
• General nail care
  • Keep the nails short
  • Protect your nails from damage 
  • Do not clean underneath the nails with sharp objects or nail brushes; instead, soak affected nails in soapy warm water to remove debris
  • Rub moisturizer into the nail and cuticle or soak them in emollient oils 
  • Soak toenails for at least 10 minutes in a bowl or bath of warm water, to soften the nails before gently filing the thickened part of the toenails with an emery board
    • Use good, sharp scissors to trim off small pieces of the nails
    • Cut straight across the toenail, to help prevent it from becoming ingrown
  • Always wear comfortable shoes with sufficient room for the toes; friction can cause toenail thickening to occur
    • Consider buying shoes a size larger than the usual size