This article will discuss what is 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 should consult a doctor, as the lack of timely therapy can lead to irreversible processes in the joints.
Psoriatic changes in the nail plates
Nail damage in psoriasis occurs in 80% of patients. This is a systemic disease in which not only the condition of the nail plates worsens, but also pathologically active division of epidermal cells develops, the deposition of keratin and fats is disturbed, due to which the stratum corneum of the skin becomes elastic and durable, changes occur in the musculoskeletal system and internal organs.
Nail psoriasis (photos of affected nails, to put it mildly, are unpleasant) has a variety of forms. At the initial stage, 3 signs develop:
- point dystrophy of the nail plate (thimble syndrome), when pointgrooves and surface of the nail resembles a thimble;
- slight itching, burning;
- papular psoriasis, in which small nodules appear on the bed of the nail.
In the later stages of the disease, the following symptoms appear:
- subungual hyperkeratosis, or keratinization of the nail bed;
- pain, discomfort;
- increasing the 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, translucent through the nail in the roller area;
- separation of the nail plate at the end of the phalanx of the finger;
- inflammation of the periungual fold;
- leukonychia - white spots;
- redness of the skin under the nail, hemorrhages in the form of bands.
Nail deformation
Often patients experience a change in the shape of the nail plate:
- onychogryphosis - thickening of the nail, as a result of which it looks like a claw of a bird of prey;
- onycholysis - detachment;
- in rare cases, destruction with complete discharge.
Typical changes in psoriasis of the nail plate (the photo above schematically shows what changes are observed in the disease) are characteristic of the advanced stage of the disease.
Nail and joint involvement is most common in patients over the age of 40.
Differences from other types of onychodystrophy
Fungal infectionnail (onychomycosis) in its symptoms is very similar to nail psoriasis. The photo below schematically shows what the affected nails look like in various diseases.
In both cases, the nail separates 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 becomes brown or dark;
- with psoriasis, unlike a fungal disease, there is no unpleasant smell 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 within the competence of a dermatologist. Self-administration of drugs is not recommended, as 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, it may also be necessary to consult an endocrinologist andimmunologist. In the absence of a specialized doctor, the treatment is prescribed by the therapist.
Causes of nail plate psoriasis
The exact origin of this disease has not yet been clarified. Among the violations that can lead to it, the following are distinguished:
- viral diseases;
- deterioration of metabolism;
- genetically determined defects in blood capillaries in the skin;
- neurological disorders;
- congenital instability of cellular elements and keratin deposits in the skin.
Risk factors are:
- decreased immunity;
- injury to the nail plate;
- dramatic climate change;
- stress and fatigue;
- long-term use of antibacterial agents.
Diagnosis
The diagnosis of "psoriasis of the nail plate" is carried out on the basis of an external examination and the exclusion of a fungal infection. To do this, take a scraping or a small piece of the nail, which is used for culture, microscopic examination and determination of sensitivity to antifungal drugs. In some patients, ochcomycosis and psoriasis are present at the same time.
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 blood tests.
Possible Complications
Psoriasisnail 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 who note the following changes is deteriorating:
- difficulty working with small objects, limitation of physical activity;
- psychological and social problems due to the unaesthetic appearance of the hands, the deterioration of the emotional state;
- decrease in tactile sensations;
- soreness;
- difficulties in tying shoelaces, sewing on buttons and other household activities.
How to treat nail psoriasis?
Despite the fact that there are currently many drugs for the treatment of psoriasis, effective treatment of nails is a challenge. This is due to several reasons:
- difficulty in penetration of drugs into the nail bed;
- high toxicity of systemic drugs;
- the need for a long course.
The choice of treatment method depends on the symptoms and severity of the pathology. If the damage to the nails is insignificant, then only external agents are used. Systemic drugs are prescribed in the following cases:
- extensive skin rashes;
- severe nail damage;
- psoriasis in pustular form;
- inefficiency of external therapy;
- distribution of the psoriatic process to the joints.
External preparations
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 "Elok-S", "Mometasone-Akrikhin", "Momat", "Uniderm". They are applied to the nail bed and adjacent areas of the skin. As side effects, the appearance of spider veins (nets), atrophy of the periungual ridge and phalanx is noted.
- Ointments, gels and creams containing calcipotriol, an analogue of vitamin D (Calcipotriol, Daivonex, Daivobet, Xamiol). Studies show that using them 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 - Dermovate, Clobetasol, Cloveit.
- Cyclosporin solution showing efficacy against hyperkeratosis and flaking of the nail.
- Topical preparations based on the retinoid tazarotene - "Zorak", "Tazorak", "Tazarotene". They help to reduce hyperkeratosis, "oil spots", exfoliation of nails. Feelings of irritation, burning, or flaking may occur as side effects.
- Creams and ointments containing 5-fluorouracil - Belanix, Efudix, Flonida, fluorouracil ointment. Before treatmentit is recommended to try these products on one nail, as irritation reaction, hyperpigmentation and destruction of the nail are possible.
Systemic Therapy
In severe cases, treatment of nail psoriasis is carried out using systemic remedies:
- Retinoids (synthetic derivatives of retinoic acid) - "Etretinate", "Acitretin". These drugs are used in the treatment of psoriasis in a pustular form, with subungual hyperkeratosis, however, there are side effects: the appearance of white spots on the nails, an increase in their fragility and inflammation of the periungual ridge. Also, while taking these drugs, it is necessary to monitor the condition of the liver.
- Cyclosporin. Drugs based on it ("Ekoral", "Cyclosporin", "Panimun 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 changes 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, new methods are being sought to cure nail psoriasis. One of these recent developments was the immunomodulators Alefacept 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.
Drugs representa lyophilisate for the preparation of injections. "Alefasept" is administered intramuscularly, and "Infliximab" - intravenously. After 12-22 weeks from the start of treatment, the symptoms of nail psoriasis completely disappear in 50% of patients. The side effects of these drugs are much less than those of the systemic agents described above. The disadvantages of such treatment include its high cost.
Physiotherapy
Of the physiotherapeutic methods, PUVA and X-ray irradiation are used. PUVA therapy helps eliminate nail exfoliation, removes subungual hyperkeratosis, "oil spots", reduces inflammation in the skin and reduces longitudinal cracking of the nail plate. The essence of the treatment is to take psoralen, a plant-derived substance that has a photosensitizing effect.
The skin becomes more receptive 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 occurs in special cabins, reminiscent of solarium equipment. There are also compact portable units for influencing 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 irradiation of 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 dose accumulationX-ray exposure, this method has only a temporary effect.
Traditional medicine
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 s alt 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. The infusion is filtered and slightly cooled. The water temperature should be about 40 ° C, and the duration of treatment should be 15 minutes. The procedure is carried out 2-3 times a day until the symptoms are eliminated. To improve blood circulation and tissue nutrition, treatment can be combined with contrast baths.
- Seaweed therapy. To do this, use fresh or dry leaves of kelp. It contains a large number of micro and macro elements, vitamins. The polysaccharides included in its composition affect 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), allowed to swell for 0.5-1 h and applied to the fingers for 15-20 minutes, then washed off. Course - 2 weeks. After consultation with a specialist, the course can be repeated if necessary.
- For the treatment of psoriasis in traditional medicine, a decoction of bay leaves is also used, which is taken orally and used as baths. For its preparation 2 tbsp. l. chopped leaves pour boiling water, simmer for 10 minutes. for them to 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 pine tree oils, which have an antifungal effect.
Vitamin Therapy & Nutrition
Vitamin therapy is one of the necessary components in the complex treatment of psoriasis. Vitamins of group B, ascorbic and folic acid, vitamins A, E, PP, trace elements calcium and phosphorus help to 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 nails and hair.
Nutrition for psoriasis should be complete and fortified. It is recommended to exclude from the diet foods that irritate the gastric mucosa and disrupt the liver (spicy, s alty, fried, fatty, smoked), as this impairs the elimination of toxins from the body. It is necessary to increase the number of vegetables and fruits that improve intestinal motility.
