Nail Psoriasis: Signs, Symptoms, and What to Look For

NOTE: The information below is based directly on Doug Schoon’s explanation in the video above.

Nail psoriasis most often occurs in people who already have psoriasis of the skin. About 5% of individuals with psoriasis will show symptoms only in the nails, while up to 75% of those with psoriatic arthritis have nail involvement.

There is no cure for nail psoriasis. Symptoms may come and go and can reappear without a clear cause. The condition can weaken the nail plate, making it more likely to peel, split, break, or develop infections. Nails may also become thicker, change shape or color, and may feel tender or painful.

Nail psoriasis is not caused by pathogens, so it is not contagious. It has a genetic component and tends to run in families, with about a 20% chance of developing psoriasis if a parent or sibling is affected.

Common Signs of Nail Psoriasis

Signs can vary, and any one symptom alone may have other causes. However, multiple symptoms appearing together should be evaluated by a medical professional. These may include:

• Salmon-colored or reddish spots under the nail (salmon patches)
• Nail plate discoloration (green, yellow, or brown)
• Small pits in the nail surface
• Rough, uneven nail texture
• Thickening under the nail from chalky buildup
• Separation of the nail plate from the nail bed (onycholysis)
• Crumbling or brittle nail edges
• Splinter hemorrhages (thin black lines under the nail)
• Redness in the lunula (the “moon” area)
• Inflammation around the nail (paronychia)

Care and Management

Nail psoriasis can be covered with nail cosmetics, including gel or enhancements. To reduce damage, nails should be kept short and filed smooth. Protective gloves are recommended during cleaning or manual work, and regular use of a skin conditioner helps prevent dryness. Properly fitting shoes are important to avoid pressure on toenails.

Artificial nails may help protect the nail plate from further damage. However, individuals with psoriasis should be aware of the Koebner phenomenon, where skin trauma can trigger symptoms.

Treatment Considerations

Medical treatments are available but vary in effectiveness depending on severity. These may include topical, oral, or injectable medications prescribed by a healthcare provider. Because nails grow slowly, improvement can take months.

Phototherapy using UV light is sometimes used medically, but the level of UV exposure in clinical treatment is far greater than what nail lamps provide. Nail lamps are not expected to produce therapeutic effects.

A proper diagnosis and treatment plan should always come from a qualified medical professional.

Big thank you to Doug Schoon for sharing this information. Doug has been one of my mentors for years, and honestly, so much of what I understand about nails comes from learning from him. His book Nail Structure and Product Chemistry is what I always call my “nail bible”—it’s where the real science lives. If you’re curious and want to go deeper, you can find more of Doug’s work here: https://www.schoonscientific.com/