From glamour.com
Don’t let your nail psoriasis impact your quality of life
We all have those moments where we find ourselves self-consciously hiding our nails. Maybe it’s because they’re nibbled or nicked, or in desperate need of a good cuticle taming. Luckily, in most cases it’s easy enough to hide less-than-pretty nails. We keep our hands in our lap during a work meeting, blur our nails in Instagram closeups, and regularly thank whoever invented pockets and started putting them in dresses and skirts too. If you’re someone with nail psoriasis, though, feelings of nail-consciousness can become nonstop—and start to seriously impact your quality of life.
This condition involves nail changes that can become difficult to ignore or cover up, even with a fresh manicure: fingernails or toenails that are pitting, grooved, rough, thickened, or even crumbling. Other common signs of nail psoriasis include discoloration of the nail plate and/or nail bed, super-skinny streaks of blood under the nail plate (google “splinter hemorrhage” for a helpful visual), nails that are separating from the nail bed (known as onycholysis) and red spots on the lunula, that little half-moon at the base of your nails. (Who knew it had such a cute name?) You might also experience something called subungual hyperkeratosis, where chalky skin constantly builds up under your nail. Aesthetic and psychological concerns aside, nail psoriasis can also become physically uncomfortable and even painful to live with—on a whole other level than when a toe hangnail catches on your sheets.
Like plaque psoriasis—the most common form of psoriasis, which produces rough, thick patches of skin on various parts of the body—nail psoriasis is a chronic inflammatory condition that has some genetic links and environmental triggers and isn’t curable, but thankfully is treatable. The two conditions usually go hand in hand: Nail psoriasis typically appears after moderate to severe psoriasis has already cropped up elsewhere on the body, and its prevalence among people with a psoriasis diagnosis is high—about half of the people with plaque psoriasis and 80% of people with psoriatic arthritis (a type of psoriasis involving joint pain/stiffness) do experience some nail involvement. That said, it’s possible to experience nail psoriasis without having any other symptoms of skin disease.
Treatment of nail psoriasis begins with a visit to a dermatologist, who will perform an exam to confirm the diagnosis—rarely, this may involve a nail biopsy—and rule out other conditions that can prompt similar nail changes, like a fungal infection (onychomycosis).
Your dermatologist will then prescribe a treatment, which can be local and topical, systemic, or sometimes a combination. One important thing to keep in mind about treatment of nail psoriasis is that more often than not, it takes some trial and error to find the combination of medications that works for you, so don’t get frustrated if you don’t see results on the first go-round. If your nail psoriasis symptoms are mild (according to the nail psoriasis severity index) and/or just a few nails are affected, your dermatologist may first prescribe a topical steroid or retinoid treatment (such as tazarotene) that you apply once or twice a day. There’s also evidence that massaging a vitamin D cream or ointment into the cuticles for five minutes twice a day can help ease the symptoms of nail psoriasis.
If your nail psoriasis is stubborn or more severe, or if you also have plaque psoriasis symptoms elsewhere on your body or experience symptoms of psoriatic arthritis, such as joint pain and stiffness, you’ll likely also be prescribed a systemic treatment that targets inflammation throughout your body; these can include corticosteroids, drugs like methotrexate, or biologic therapies. Other treatment options include intralesional injections of medication under your nails, laser treatments, or phototherapy, where you expose the affected areas to regular, targeted doses of ultraviolet light in a dermatologist’s office.
When treating nail psoriasis, patience is key: Because nails grow slowly and create a barrier that makes it difficult for medications to penetrate, it can take several months for treatment to take effect and up to a year to see your nails get fully back to normal—even when using systemic therapies. It’s important to stick with your treatment plan, since not treating psoriasis of the nails can lead to complications like nail loss or even trouble using your hands and feet.
In the meantime, practicing some good nail care habits recommended by the National Psoriasis Foundation can help keep nail psoriasis from getting worse. These include keeping your nails short, wearing gloves when you’re doing yard work or cleaning, and using hand cream every time you wash your hands or shower. You should also avoid biting, cutting, or pushing your cuticles, and digging under your nail tips to clean them, since all of the above can lead to infections that can make your nail psoriasis flare up. And while buffing and painting nails can be a great way to camouflage nail psoriasis, it’s best to avoid gel or acrylic nails, which can cause irritation and also increase the risk of your nail separating from your finger. One more factor to keep in mind is that while phototherapy can be helpful in treating psoriasis within a dermatology office, exposure to the sun can often exacerbate nail psoriasis, so putting sunscreen on your hands regularly (to coat any affected skin around or under your nails) is a smart habit to adopt.
Finally, if you get sick of hiding your hands while waiting for treatment to fully clear your symptoms, just open up and share that you have psoriasis of the nails—not a contagious nail disease. After all, most people are probably self-conscious about their own nibbled stubs or shaggy cuticles and totally won’t judge. And who knows? Nail psoriasis isn’t particularly well-known; maybe the information will be helpful to them.
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