Psoriatic Arthritis Nail Symptoms: 8 Common Signs (With Pictures)

Your nails are an important part of your body, and they can tell you a lot about your health. For example, certain changes in your nails could be a sign of psoriatic arthritis — an autoimmune condition that affects different joints in your body. In fact, up to 8 in 10 people with psoriatic arthritis notice nail changes like discoloration, dents, and nail thickening.

The nail changes in people with psoriatic arthritis are more than just a cosmetic problem. They can cause pain and discomfort and make it hard to work with your hands. Knowing what signs to look for in your nails can help you get evaluated and treated early and improve the look and function of your nails.

What are the 8 signs of psoriatic arthritis in your nails?

Below are eight nail symptoms and images of psoriatic arthritis, from most to least common. 

Keep in mind that many of these nail changes can also happen in other conditions. So experiencing these changes doesn’t mean that you have psoriatic arthritis (or psoriasis). But if you do have these nail changes, it’s a good idea to talk with a healthcare professional. 

1. Nail pitting

Nail pitting is the most common nail change in psoriatic arthritis. Pits appear as tiny dents in the nail plate. One or more nails can be affected, and there can be just a couple or dozens of dents on each nail. People with eczema and alopecia areata can also have nail pitting.

2. Onycholysis

Onycholysis happens when part of your nail detaches from the nail bed, causing it to turn white. It usually starts at the tip of your nail and spreads toward your cuticle. When this happens, different bacteria can collect in the space under the nail, increasing the risk of infection. If onycholysis is really severe, you can completely lose your nail.

You can also get onycholysis from:

• Nail trauma

• Fungal infection of the nails

• Hyperthyroidism

• Certain medications, like tetracycline

3. Subungual hyperkeratosis

Subungual hyperkeratosis is a thick scale that forms underneath the tip of your nail. This happens when the cells from your nail bed don’t shed like they’re supposed to. Nails with this change can get in the way of everyday activities.

4. Color changes in the nail

Psoriatic arthritis can cause different color changes in your nails, like: 

• Oil drops or salmon patches: These are oily-looking or small, yellow-pink patches on the nail bed. These are usually only seen in psoriasis or psoriatic arthritis. 

• Leukonychia: These are small, white dots or lines on the nails. These changes can happen for many reasons, including trauma to your nail.  

• Splinter hemorrhages: These are red lines formed by blood under the nail. They can also occur in other conditions, like bacterial endocarditis (a rare type of heart infection). 

5. Nail ridges (trachyonychia)

Trachyonychia refers to nail ridges that form vertically — along the length of the nail. They can make the nail feel rough and even like sandpaper when really severe. Many other conditions can cause nail ridges, like alopecia areata.  

6. Beau’s lines

Beau’s lines are a different type of ridge that develop horizontally — across the nail. In psoriasis, they usually happen on more than one nail at a time. You can also get Beau’s lines from other causes, like nail trauma. 

7. Nail crumbling

Psoriatic arthritis can cause nails to look crumbly, like broken cookies. This is because inflammation weakens the nail matrix (the part of the nail that forms the hard nail plate).

8. Nail thickening

Psoriatic arthritis can cause thickening of the nails. That’s because the cells that make up nails and skin grow too quickly and don’t shed properly in psoriasis.

Why does psoriatic arthritis affect your nails?

For the same reason that psoriatic arthritis can affect the skin, it can also affect the nails. This is because the nails are an extension of the skin and are made up of the same types of cells and proteins. 

In psoriasis, skin cells grow too fast, causing thick patches of skin to form. This same process can happen in the nails. Changes in the nail depend on the part of the nail that’s affected by psoriatic arthritis. 

Some people with psoriatic arthritis have nail symptoms before they develop arthritis, and others develop nail changes later. But if you have psoriasis rashes and nail changes, you’re more likely to develop psoriatic arthritis in the future.  

How do you treat psoriatic arthritis nail symptoms?

There are many treatments for nail symptoms in psoriatic arthritis. Which treatment you use depends on a couple of things, like how much your nails bother you and if you also need treatment for psoriasis or psoriatic arthritis. Before starting treatment, your provider may also make sure you don’t have a nail infection that needs to be treated. 

Keep in mind that nails grow very slowly, so it can take several months or even a year to notice real improvement after starting treatment. And you may need to use more than one medication at a time to get faster results. Below, we’ll review some of the main treatments for psoriatic nails. 

Treatment applied to the nails (topicals)

If your nail changes are mild, you can apply different prescription creams directly to the nail. Examples include: 

• Strong corticosteroids, like clobetasol

• Calcipotriene (Dovonex)

• Tazarotene (Tazorac) 

Treatments done at the office

If your nail changes are more severe — or if you have a lot of nails involved — getting a stronger treatment at a doctor’s office may help. You can do this in combination with topical treatments. 

Here are some common in-office treatments:

• Corticosteroid injections use a small needle to put medication directly in or around your nails.

• Laser treatments use different wavelengths of light targeted directly on your nails. 

• Psoralen and ultraviolet A (PUVA) which uses light treatments on your nails combined with psoralen (a medication you soak your hands in or take as a pill). 

Systemic treatment (treatment throughout the whole body)

Sometimes stronger medications are needed, especially if you also have psoriatic arthritis or psoriasis on your skin. These medications are called “systemic” because they treat the entire body. 

Systemic treatments usually come as pills or injections. Examples include:

• Methotrexate (Trexall)

• Apremilast (Otezla)

• Biologics like adalimumab (Humira) and infliximab (Remicade)

Other tips for managing psoriatic arthritis nails

Taking care of your nails is especially important if you have nail psoriasis. Here are some steps you can take to protect your nails and keep the symptoms under control:

• Cut your nails regularly to keep them short.

• Wear gloves when doing manual work, like washing dishes or yard work. If you’re working with water, use a cotton glove underneath a vinyl or nitrile glove. 

• Moisturize your hands regularly — the thicker the moisturizer, the better. 

• Avoid picking or biting your nails and the skin around them.

• Avoid artificial nails. It’s OK to use regular nail polish and to gently buff your nails. 

When to contact a doctor about psoriatic nails

If changes in your nails are bothering you, talk with your primary care provider to figure out the next best steps. Together, you’ll decide if the changes you notice could be related to your psoriasis or something else. They may refer you to a dermatologist (skin specialist), since they are the experts when it comes to nail changes.

Why trust our experts?

Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Samantha C. Shapiro, MD

Samantha Shapiro, MD, is a board-certified rheumatologist and internist with expertise in autoimmune and inflammatory conditions. She founded the division of rheumatology at Dell Medical School at The University of Texas at Austin.

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Images used with permission from VisualDx (www.visualdx.com)