This article will discuss what constitutes nail psoriasis, what are the causes of the disease, its manifestations and treatment. This pathology is an important diagnostic sign of psoriatic arthritis. If the symptoms listed below are found, and there are no skin rashes, then you need to see a doctor, since the lack of timely therapy can lead to irreversible processes in the joints.
Psoriatic changes in the nail plates
Nail damage in psoriasis is observed in 80% of patients. This is a systemic disease in which not only the condition of the nail plates worsens, but pathologically active division of epidermal cells also develops, keratin and fat deposition are disturbed, due to which the stratum corneum of the skin becomes elastic and strong, changes occur in the musculoskeletal system and internal organs.
Nail psoriasis (photos of affected nails, to put it mildly, unpleasant) is characterized by various forms. At the initial stage, 3 signs develop:
- point dystrophy of the nail plate (thimble syndrome), when point recesses appear and the surface of the nail resembles a thimble;
- slight itching, burning;
- papular psoriasis, in which small nodules appear on the bed of the nail.
At later stages of the disease, the following symptoms appear:
- subungual hyperkeratosis, or keratinization of the nail bed;
- pain, discomfort;
- increasing fragility of nails, changing their color (they turn yellow);
- deep transverse or longitudinal grooves on the nail plates;
- "oil spots" - yellow, reddish or brown spots with a diameter of several millimeters, visible through the nail in the area of the roller;
- separation of the nail plate at the end of the phalanx of the finger;
- inflammation of the periungual roller;
- leuko-onychia - white spots;
- redness of the skin under the nail, hemorrhage in the form of stripes.
Nail deformation
Often patients have a change in the shape of the nail plate:
- onychogryphosis - a thickening of the nail, as a result of which it takes the form of a claw of a bird of prey;
- onycholysis - exfoliation;
- in rare cases, destruction with complete discharge.
Typical changes in psoriasis of the nail plate (the photo above schematically shows what changes are observed with the disease) are characteristic of the advanced stage of the disease.
Damage to nails and joints is most often observed in patients over the age of 40 years.
Differences from other types of onychodystrophy
Fungal nail damage (onychomycosis) in its symptoms is very similar to nail psoriasis. The photo below schematically shows how the affected nails look with different diseases.
In both cases, the nail is separated from its bed at the end of the phalanx, but there are some differences:
- fungal infection most often first appears on the fingers, and then spreads to the nails;
- with onychomycosis, the nail plate acquires a brown or dark color;
- with psoriasis, unlike a fungal disease, there is no unpleasant odor from the nails.
With eczema, dystrophic changes in the nail plate and inflammation of the surrounding skin are also observed. A characteristic feature of this disease is that the edge of the nail adjacent to the posterior roller is affected, and not the free end. With lichen planus, damage to the nail plate is almost always combined with characteristic skin rashes. Before prescribing treatment, a differential diagnosis of these diseases is carried out.
Which doctor treats this disease?
Nail psoriasis and its treatment are the responsibility of a dermatologist. Self-medication is not recommended, since it is necessary to determine the exact diagnosis. Similar symptoms occur with other dermatological diseases that require the use of special medicines.
Depending on the factors that caused the damage to the nail plate, consultation with an endocrinologist and immunologist may also be required. In the absence of a specialized doctor, therapist prescribes treatment.
Causes of psoriasis of the nail plate
The exact origin of this disease has not yet been elucidated. Among the violations that can lead to it, the following are distinguished:
- viral diseases;
- metabolic decline;
- genetically determined defects of blood capillaries in the skin;
- neurological disorders;
- congenital instability of cellular elements and keratin deposition in the skin.
Risk factors are:
- decreased immunity;
- injuries of the nail plate;
- dramatic climate change;
- stress and overwork;
- long-term use of antibacterial agents.
Diagnostics
The diagnosis of "nail plate psoriasis" is carried out on the basis of external examination and exclusion of fungal infection. To do this, take a scraping or a small piece of the nail, which is used for backseeding, microscopic examination and determination of sensitivity to antifungal drugs. In some patients, ohnomycosis and psoriasis are present simultaneously.
There are no specific tests to determine this disease. Since nail psoriasis is an unfavorable diagnostic factor, often indicating the development of rheumatic processes, the doctor may prescribe a blood test.
Possible complications
Psoriasis of the nail bed and plate is not only a cosmetic defect. It can lead to the following complications:
- atrophy;
- complete destruction of the nail;
- growth of the nail plate.
The quality of life of patients is deteriorating, who note the following changes:
- difficulty working with small items, limiting physical activity;
- psychological and social problems in connection with an unaesthetic look of hands, deterioration of the emotional state;
- decreased tactile sensations;
- soreness;
- difficulties in tying shoelaces, sewing buttons and other household activities.
How to treat nail psoriasis?
Despite the fact that currently there are many drugs for the treatment of psoriasis, effective treatment of nails is a certain problem. There are several reasons for this:
- the difficulty of penetration of drugs into the nail bed;
- high toxicity of systemic drugs;
- the need for a long course.
The choice of treatment depends on the symptoms and severity of the pathology. If the damage to the nails is not significant, then only external agents are used. Systemic drugs are prescribed in the following cases:
- extensive skin rashes;
- severe nail damage;
- psoriasis in a pustular form;
- inefficiency of external therapy;
- the spread of the psoriatic process to the joints.
Outdoor drugs
The following drugs are used as external agents for the treatment of psoriasis of the nail plate:
- Corticosteroid ointments, creams, lotions with mometasone - "Elok" and "Elokom-S", "Mometazon-Akrikhin", "Momat", "Uniderm". They are applied to the nail bed and adjacent areas of the skin. As side effects, the appearance of spider veins (reticuli), atrophy of the periungual platen and phalanx are noted.
- Ointments, gels and creams containing calcipotriol, a vitamin D analogue (Calcipotriol, Dayvoneks, Dayvobet, Xamiol). Studies show that their use twice a day for 6 months leads to a significant reduction in hyperkeratosis (thickening and deformation of the nail plate) in 70% of patients.
- Ointments, creams and nail polishes based on clobetasol - “Dermoveit”, “Clobetasol”, “Cloveit”.
- Cyclosporin solution, showing efficacy against hyperkeratosis and exfoliation of the nail.
- Local preparations based on tazarotene retinoid - "Zorak", "Tazorak", "Tazaroten". They help reduce hyperkeratosis, "oil stains", peeling of nails. As side effects, you may experience a feeling of irritation, burning, or peeling.
- Creams and ointments containing 5-fluorouracil - "Belanix", "Efudiks", "Flonida", fluorouracil ointment. Before treatment, it is recommended to test these products on one nail, as a reaction of irritation, hyperpigmentation and destruction of the nail is possible.
Systemic therapy
In severe cases, treatment of nail psoriasis is carried out using systemic drugs:
- Retinoids (synthetic derivatives of retinoid acid) - "Etretinate", "Acitretin". These drugs are used in the treatment of psoriasis in the pustular form, with subungual hyperkeratosis, but there are also side effects: the appearance of white spots on the nails, an increase in their fragility and inflammation of the periungual roller. Also, while taking these drugs, it is necessary to monitor the condition of the liver.
- Cyclosporin. Drugs based on it ("Ecoral", "Cyclosporin", "Panimune Bioral" and others) are powerful immunosuppressants. Treatment is often combined with external agents containing calcipotriol. Long-term use can lead to impaired renal function and a change in blood pressure. Therefore, this substance serves as a second-tier drug in the treatment of psoriasis.
Means of biological action
In modern medical science, a search is underway for new methods to cure nail psoriasis. One of these recent developments has become the immunomodulators Alefasept and Infliximab. They are able to inhibit the abnormal activity of T-lymphocytes in the affected skin, while not affecting the rest of the immune system.
The preparations are lyophilisates for the preparation of injections. Alefasept is administered intramuscularly, while Infliximab is administered intravenously. After 12-22 weeks from the start of treatment, symptoms of nail psoriasis completely disappear in 50% of patients. The side effects of these drugs are much less than the systemic drugs described above. The disadvantages of this treatment include its high cost.
Physiotherapy
Of the physiotherapeutic methods, PUVA and x-ray irradiation are used. PUVA therapy helps to eliminate the detachment of the nail, removes subungual hyperkeratosis, "oil stains", reduces inflammation in the skin and reduces longitudinal cracking of the nail plate. The essence of treatment is to take psoralen - a substance of plant origin, which has a photosensitizing effect.
The skin becomes more susceptible to light, and photochemistry helps to destroy excess T-helper cells in the skin and reduce the process of cell division. Irradiation with ultraviolet light takes place in special cabins resembling equipment for a solarium. There are also compact portable devices for treating small areas of the skin during the treatment of nail psoriasis (photo below).
Therapy with weak x-rays was proposed by German and Swiss doctors. They found that irradiating the fingers with three doses of 150 kGy each helps to reduce the thickness of the nail and reduce the destructive processes in it. However, in addition to the accumulation of x-ray doses, this method has only a temporary effect.
ethnoscience
Drug treatment of nail psoriasis at home can be combined with traditional medicine recipes:
- Baths with infusion of chamomile, calendula or sage. These herbs have an anti-inflammatory effect, as well as a weak antiseptic. If psoriasis is combined with a fungus, then it is recommended to add a few drops of tea tree oil or sea salt to the infusion. The tool is prepared as follows: 2 tbsp. l dry raw materials pour 2 tbsp. boiling water and insist in a thermos for half an hour. If it is necessary to treat toenails where the skin is rougher and the nails are thicker, then the number of flowers is increased by 2 times. Filter the infusion and cool a little. The water temperature should be about 40 ° C, and the duration of treatment is 15 minutes. The procedure is carried out 2-3 times a day until the symptoms are eliminated. To improve blood circulation and tissue nutrition, you can combine processing with contrasting baths.
- Seaweed Therapy. For this, fresh or dry kelp leaves are used. It contains a large number of micro and macro elements, vitamins. The polysaccharides included in its composition have an effect on cellular immunity, destroy the membranes of malignant cells and make them permeable to cytotoxic substances. Laminaria powder is diluted with water at room temperature (hot water can lead to the destruction of nutrients), allow it to swell for 0.5-1 hours and applied to the fingers for 15-20 minutes, then rinse off. The course is 2 weeks. After consulting a specialist, the course can be repeated if necessary.
- For the treatment of psoriasis in folk medicine, a decoction of bay leaf is also used, which is taken orally and used as a bath. For its preparation, 2 tbsp. l chopped leaves pour boiling water, simmer over low heat for 10 minutes. so that they swell. Then the broth is filtered and drunk during the day in 3 divided doses. The duration of therapy is 1 week.
To soften the nail and the skin around it, it is recommended to rub oils daily - olive, sunflower or coniferous oils, which have an antifungal effect.
Vitamin Therapy and Nutrition
Vitamin therapy is one of the necessary components in the complex treatment of psoriasis. Vitamin B, ascorbic and folic acid, vitamins A, E, PP, trace elements calcium and phosphorus help preserve the structure of the nail. When choosing a drug, preference should be given to vitamin-yeast complexes. Brewer's yeast is a natural remedy that promotes the growth of the nail plate, and the sulfur contained in it is necessary for the formation of keratin in the nails and hair.
Nutrition for psoriasis should be full and fortified. It is recommended to exclude from the diet foods that irritate the gastric mucosa and disrupt the liver (spicy, salty, fried, fatty, smoked), as this worsens the elimination of toxins from the body. It is necessary to increase the number of vegetables and fruits that improve intestinal motility.