Psoriasis is an autoimmune disorder.  It is an inflammatory disease that occurs in genetically susceptible individuals, as it is genetic and runs in the family.  It manifests itself in patches of scratchy, scaly skin, or plaques, that can appear on all parts of the body.  It can even be seen in fingernails and toenails.

In the toenails, psoriasis appears as many small "pits,"  or punctate indentations.  There may also be streaks or ridges, or even what appears to be craters that form.  If it affects the skin under the nail, it can appear as thickened skin, or a callus under the nail.  At times, it may cause separation of the nail from the nailbed and cause the nail to come off the nail bed.  The patient may lose the nail all together, leaving a bare nail bed.  

Sometimes a patient may see an oildrop sign or salmon colored patch, a transparent discoloratoin to the nailbed.  This occurs when psoriasis affects the nailbed itself, and the discoloration eventually grown out.  

Often times there is concurrent onychomycosis, or fungal infection, of the nail.  A fungal nail has the same appearance, but a way to find out the correct diagnosis is via a simple nail biopsy.  This is done in the office by our doctors, and sent to a dermatopathology lab, specific for podiatric diagnoses.  

Treatment for a psoriatic nail is first a topical medications, such as topical steroids or 8% clobetasol propionate, which is applied to the nail itself.  When topical medication has failed, then patients seeing their rheumatologist or dermatologist would discuss oral or injectable medications that treat psoriasis itself, and once the disease process is controlled, the manifestation on the nails also is reduced.  

If you have any questions regarding your toenails, give our office a call 630-834-3668.  Our doctors will perform a throrough exam, discuss nail biopsy options, and a treatment plan.