Most of us know psoriasis as a condition that causes scaly dry patches on the skin. But psoriasis can also wreak havoc on the nails, causing pitting, thickening, scaling, separation, discoloration, and pain. Other symptoms can include black or red dots below the nail plate and horizontal lines (Beau’s lines). Statistics from the American Academy of Dermatology estimate anywhere from 10%-55% of people with psoriasis of the skin will have the condition on their nails.
Don’t make the mistake of trying to make a diagnosis. First, the broad symptoms of nail psoriasis make it difficult to distinguish from many other conditions. Second, the law clearly restricts techs from offering medical assessments. This puts us in the unique position of trying to educate clients without giving them false security that we can provide treatment for their condition. The conversation may go something like this:
You: At first, I thought your nails were splitting from being dehydrated, but this scaling on your nail is getting worse. It almost looks as if this nail is getting thicker than the others. Let me ask: Have you ever had any skin conditions? Psoriasis, maybe?
Client: No, that’s not what it is. I don’t have psoriasis.
You: Well, it’s a low number, maybe only about 5%, but people without psoriasis on the skin can still develop psoriasis on the nail plate or even on the skin under the nail. It’s more common in people who also have psoriasis on the skin, but not exclusive to them.
Client: Really? Well, now that you’re mentioning it, that’s not the only nail with trouble. Look at my toenail. This one is the worst.
You: Yes. I can see the problem. There’s some pitting on the nail plate; it’s thick and somewhat discolored. It also looks as if it’s separating from the skin, which puts you at a risk for trapping dirt and bacteria and getting a fungal infection. I’m not in a position to tell you what it is, or even what I think it is. Many nail conditions have similar symptoms and can show up in a variety of different ways. Psoriasis, for example, can turn the nails a brownish yellow, and it could have red spots underneath the nail — though not necessarily. All the variations mean it’s necessary to consult with a doctor, both to protect you and other clients. I need to know what it is so I can confirm it’s not contagious.
Client: OK, I’ll call my dermatologist, but for now, will you please just cover it up? I don’t like the way it looks.
You: I’ll do my best. I’ll give you a pedicure and finish your fill. On your toes, I’m going to file the rough edges and keep the nails short. I’ll moisturize the skin and add oil as I always do. It’s important for you to continue this daily at home. For your fingernails, I’ll add enhancements on all the unaffected nails, but on the one nail that is showing trouble, I’m going to take the product off. We can match the color of the polish so it’s not as obvious. But I want the doctor to be able to remove the polish easily to make an accurate assessment.
Schedule your appointment as soon as you can, and make sure you ask for a release that lets us both know that the products we use here — the polish, gel, or acrylic — won’t worsen your condition.
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