psoriasis

n. ( s   r¯i  /   s s) a chronic noncontagious skin disease characterized by inflammation and white scaly patches; can appear in the form of pitting and thickening on the nails.

What It Is

Psoriasis is an equal opportunity offender, says Lucia Kaineg, a patient educator with the National Psoriasis Foundation (NPF). This lifelong, non-contagious skin condition can occur on any part of the body, from the scalp to the soles of the feet. According to the NPF, more than 4.5 million adults in the United States suffer from this condition. 

According to Kaineg, psoriasis most commonly appears on the knees, elbows, and scalp, but it also frequently appears on the hands and nails, which is of most concern to nail technicians.

“Nails are one of the most difficult areas to treat because the nail plate makes it difficult for the medication to get to the psoriasis and treat it,” says Kaineg.

Symptoms

Although there are five types of psoriasis, the most common one is plaque psoriasis. About 80% of people suffering from psoriasis have this form. It is characterized by raised, inflamed, red lesions covered by a silvery white scale and is typically found on the elbows, knees, scalp, and lower back, although it can occur on any area of the skin. 

Besides its unattractive appearance, people with psoriasis also may suffer from dry, itchy skin. “It can be painful. If the skin is severely dry it can crack and bleed, which can lead to infection,” says Kaineg.

Another form of this condition, pustular psoriasis, can appear on the palms and soles. It’s characterized by red plaques with scaling and swelling up to a quarter inch in size. In some places, the pustules are dried to a brownish crust. These lesions can be painful and disabling.

When psoriasis affects the nail matrix, it can show up in different forms. If it affects the most proximal portion of the matrix, psoriasis shows up as small dents on the surface of the nail plate, which can look like pock marks or pits.

Any damage to the nail matrix can cause a white spot, also known as leukonychia. If the distal portion of the nail matrix (the part farthest away from the body, including the lunula) is affected, it causes onycholysis (separation of the nail plate from the nail bed).

Although it is not common, if the nail psoriasis is severe enough to affect all three parts of the nail matrix the nail plate can crumble and be lost completely.

If the psoriasis affects the nail bed instead of the matrix, a reddish-brown discoloration resembling a small drop of oil will appear on the nail bed.

Nail psoriasis can often occur with psoriatic arthritis, which affects the fingers and is usually accompanied by swelling and redness.

Causes

Psoriasis occurs when faulty signals in the immune system cause skin cells to grow too quickly — every three to four days instead of the usual 30-day cycle — causing extra skin cells to build up on the skin’s surface. These extra skin cells form “plaques,” the red, flaky, scaly patches that appear on the skin. 

According to the NPF, this condition is measured in terms of its physical and emotional impact. Physically, if less than 2% of the body is involved, the case is considered mild. Most people have a mild case of psoriasis. Between 3% and 10% is considered moderate and more than 10% is severe. One percent of the skin is equal to the size of a palm.

Because of their genes, certain people are more likely to develop it, but a trigger is usually necessary to make psoriasis appear. Emotional stress, injury to the skin, some types of infection, and reaction to certain drugs can all trigger psoriasis.

How to Treat It

Unfortunately, there is no cure for psoriasis. However, it can be controlled. “Therapy depends on the severity of the condition,” explains Kaineg. “It all boils down to appropriate therapy for the type of psoriasis and the severity.”

Because psoriasis affects the nail when it is being formed, it can be difficult to treat. Injections with steroids into the nail bed or matrix (which are oftentimes painful) have been used with varying results. The major treatments for nail psoriasis include topical treatments such as corticosteroids.

A type of phototherapy known as PUVA, which is an acronym for psoralen (a light-sensitive medication) combined with exposure to ultraviolet light A, has brought relief to many psoriasis sufferers. PUVA slows down the excessive cell reproduction of psoriasis and can clear the symptoms for varying periods of time.

Some people may even require cosmetic surgery if their nails have been badly deformed by psoriasis.

People suffering from psoriasis on the hands and feet may find relief by using moisturizers, mild soaps, and soap substitutes. Traditional topical treatment of palm and sole psoriasis such as tar, salicylic acid, and steroids can also help control this condition. A combination of the three may offer more relief if used in conjunction.

When directed by a doctor, some topical medications may be used with occlusion, intensifying the effect of the cream or ointment. Cotton or plastic gloves can be worn over creams or moisturizers on the hands. Socks, or special occlusive foot covers can be used on the feet. Soaking the hands or feet in warm water will help speed the penetration of medications and moisturizers.

Although there may be no cure for psoriasis, advancements have been made that seem promising, says Kaineg. Unlike traditional medications, which are created by combining chemicals, biologic drugs are made from human or animal proteins. The medications made from these proteins are specifically designed to help correct the body’s process that causes psoriasis and psoriatic arthritis. Currently, four types of biologics have been approved by the FDA.

Considerations for Nail Techs

Psoriasis is not contagious so nail technicians do not have to fear that they will get it if they’re working with a client suffering from the condition. “It’s a big misconception,” says Kaineg. “You won’t catch it from a client with skin lesions. It’s a condition of the immune system.”

It is possible to work on hands, nails, and feet with psoriasis — just be gentle. Vigorous cleaning, scraping, or scrubbing can lead to further psoriasis lesions — something your client surely won’t appreciate.

Thick nails may be filed down and pitted nails can be buffed and polished. In some cases, clients can even wear enhancements, although Kaineg warns there may be a reaction to the chemicals in the nail products. “Some doctors are for it, others are not. It depends on the person. Just proceed with caution,” she suggests.

According to the NPF, toenails can be improved by soaking the feet for 10 minutes in a tub of warm water, gently filing the thickened part of the toenail with an abrasive file, and using good clippers to cut off a small piece at a time. The aim is to cut straight across the toenail to help keep it from becoming ingrown.

Also, remind clients of the importance of keeping the skin well moisturized. Suggest they wear gloves if they’ll be working a lot with their hands.

As a nail tech, you’re in a good position when it comes to dealing with clients suffering from psoriasis. Offer them gentle, soothing services that will help bring relief and make their hands and nails look that much more attractive and you’re practically guaranteed a client for life. 

Psoriasis can appear on any part of the body, including the nails and elbows.