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Nail psoriasis

April W Armstrong, MD, MPH
Section Editor
Kristina Callis Duffin, MD
Deputy Editor
Abena O Ofori, MD


Psoriasis is a common, chronic, inflammatory disease that has skin, nail, and systemic manifestations. Nail psoriasis results from psoriatic involvement of the nail bed or nail matrix.

Patients with nail psoriasis can develop a wide variety of nail changes, such as pitting, onycholysis, subungual hyperkeratosis, and nail discoloration. Patients may find the appearance of psoriatic nails psychologically distressing, and extensive cases may confer significant morbidity and functional impairments. Therefore, managing nail psoriasis is an integral part of psoriasis therapy.

The clinical manifestations, diagnosis, and management of nail psoriasis will be reviewed here. The diagnosis and treatment of other manifestations of psoriasis are reviewed separately. (See "Epidemiology, clinical manifestations, and diagnosis of psoriasis" and "Treatment of psoriasis in adults".)


Nail psoriasis occurs in both adults and children [1,2]. The prevalence of nail psoriasis among patients with psoriasis is estimated to be 10 and 55 percent [3]. In most patients, nail involvement follows or is concurrent with the onset of cutaneous psoriasis [4]. Occasionally, nail psoriasis is the sole manifestation of psoriasis at the time of clinical presentation [5].

Nail psoriasis is also strongly associated with psoriatic arthritis. It has been estimated that 80 to 90 percent of patients with psoriatic arthritis develop nail involvement [6,7]. This finding may be related to the proximity of the nail to the distal interphalangeal (DIP) joint, a site of predilection of psoriatic arthritis (picture 1A). The enthesis of extensor tendon crossing the DIP joint is linked to the nail root and nail matrix [8]. (See "Clinical manifestations and diagnosis of psoriatic arthritis".)

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Literature review current through: Oct 2017. | This topic last updated: Aug 15, 2017.
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