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

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, with just a few dents, or dozens of dents on each nail. People with eczema and alopecia areata can also have nail pitting.

2. Onycholysis

Onycholysis is 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 the nail bed don’t shed like they’re supposed to. This kind of nail damage 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, when really severe, like sandpaper. 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.

What causes psoriatic arthritis?

Scientists don’t know exactly what causes psoriatic arthritis, but it’s probably a combination of a few different things, including:

• Genetics: You’re more likely to have psoriatic arthritis if a close family member has it. 

• Environmental triggers: These vary by person and can include things like infections, smoking, stress, and certain medications. 

A combination of genetic risk and external triggers can lead to an overactive immune system, which affects the joints and skin.  

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, a healthcare professional 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. 

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 healthcare team 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’re the experts when it comes to nail changes.

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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. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

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