How can psoriasis affect your nails?

Patients with psoriasis (a condition that affects the skin and can also affect internal organs) often develop problems with their nails. Psoriatic nails look like fungal infections, so your doctor will take a snip (a biopsy) to be sure. Generally, psoriatic nails look flakier and are softer than those with fungal infections, like shingles coming off your roof with pinpoint bleeding. Even a biopsy isn't perfect; under the microscope, psoriasis is misdiagnosed as fungus one-third of the time - another reason to get a second opinion on everything. Unfortunately, treatment of psoriatic nails can be as tough as, er, nails. Sometimes the nail has to be removed, but doctors will also try light therapy, or topical, oral, and even injected steroids. New drugs like Remicade may help both nail and skin problems from psoriasis.

Nail psoriasis ranges widely in severity and can cause several visible changes to your nails. Pitting of the nails is common, as is a yellowish-pink cast to the nails, and reddening of the skin around the nail. White areas sometimes appear under the nail when tiny pockets of air are trapped between the nail and the tissue beneath the nail. In severe cases, the nails may crumble in patches or fall off entirely. At other times, nail psoriasis looks much like other nail infections, particularly a fungal nail infection.