Skip to main content

13-10-2011 | Article

Nail symptoms common in psoriasis patients


Free abstract

MedWire News: People with the skin condition psoriasis frequently have abnormalities of their fingernails and toenails, a study carried out by Italian scientists shows.

The research found that more than three-quarters of psoriasis patients had problems with their nails, with symptoms ranging from nail detachment and crumbling to pitting and discoloration.

"Our study confirms that nail involvement may be overlooked in psoriasis patients," say Dr Valeria Brazzelli (University of Pavia) and team writing in the Journal of the European Academy of Dermatology and Venereology.

Psoriasis is a chronic inflammatory disease that is characterized by red patches, scales, itching, and flaking of the skin. Alongside the skin symptoms, psoriasis can cause symptoms in the bones and joints, a form of the disease known as "psoriatic arthritis."

Nail symptoms are also known to occur in patients with psoriasis. However, these are less well-understood than the other symptoms, a gap that Dr Brazzelli's group sought to address in this study.

They recruited 178 men and women who were referred for assessment at a psoriasis treatment center in northern Italy. Nail symptoms were identified in 137 of the patients, or 76.9%.

The most common nail abnormality was onycholysis, a condition in which the nails become loose and separate from the nail bed. This was seen in nearly one-third of the patients and more often affected the toenails than the fingernails.

The next most common nail abnormality was crumbling, which again was more frequent in toenails than fingernails, and typically occurred in severe cases of nail detachment. Less common issues were nail discoloration (usually translucent yellow-red), splinter hemorrhages (tiny areas of bleeding under the nails), and leukonychia (white nails).

Pitting of the nails - where there are small depressions on the nail surface - was very common in fingernails (affecting nearly half) but almost never seen in toenails.

In patients with nail symptoms, nine nails were affected on average (five toenails and four fingernails), with the fourth fingernail and first toenail being the most frequently affected.

Finally, patients with nail abnormalities tended to have more severe skin symptoms, and were more likely to have psoriatic arthritis, than those without nail abnormalities.

Taken together, these findings confirm that "nail involvement is common in psoriasis patients," say Dr Brazzelli and co-authors.

"The prevalence of nail involvement observed in our study shows that although widely recognized, nail psoriasis is probably overlooked," they write. "The observation of preferential localization of specific patterns to hands or feet and to specific digits may facilitate detection of the disease, especially at early stages."

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Joanna Lyford