Caring for Nails with Psoriasis

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Trips to the salon for mani-pedis (or to the podiatrist’s office for medical pedicures) may be mostly a thing of the past during COVID-19, but stay-at-home orders doesn’t mean you have to settle for so-called quarantine nails either. In fact, taking the time to care for your nails is especially important now if you have psoriasis or psoriatic arthritis, two chronic conditions that commonly affect the nails.

The reason has to do with something called the Koebner phenomena, which is an inflammatory response to an injury or trauma that causes or worsens a psoriasis flare. In nails, this leads to changes like discoloration, pitting, ridging, crumbling, thickening, and onycholysis, which is when the nail becomes detached from the underlying nail bed.

“Psoriasis is really driven by the Koebner phenomena,” says Mona Gohara, MD, associate clinical professor of dermatology at Yale School of Medicine in New Haven, Connecticut. And the longer you postpone nail grooming, the more likely you are to physically traumatize your nails or the surrounding skin when you finally attend to it. “It’s a much easier job if you keep on top of it,” says Dr. Gohara.

There’s likely more to stay on top of, as well: Because stress is a key trigger for outbreaks of psoriasis, more frequent and serious outward symptoms of these conditions are likelier now due to stress and anxiety from the COVID-19 pandemic.

But in the good news department — besides providing some welcome pampering at a time of high anxiety — the right nail care can help you get the best results from the many treatments available for psoriasis.

Tips for a DIY Manicure and Pedicure with Psoriasis or Psoriatic Arthritis

If you have psoriasis or psoriatic arthritis, many of the steps of an at-home manicure and pedicure are the same as, or similar to, a traditional treatment.

The key is to avoid traumatizing your nails. “The overall handling — trimming, filing, and buffing — of your nails should be gentle,” says Jacqueline Sutera, DPM, a podiatric surgeon in New York City.

These how-tos will help your nails look their best and possibly even keep your condition from getting worse.

Keep nails short

Long nails are more prone to trauma and are likelier to separate from fingers and toes. Because of their length, they can also harbor more dirt and bacteria than short nails and contribute to the spread of infection, possibly even the coronavirus if you touch your hand to your mouth or nose.

This is why “the best nail hygiene for everyone across the board is to keep nails short,” says Dr. Gohara. Ideally, your nails won’t extend beyond the tips of your fingers and toes. If you have onycholysis, the Psoriasis and Psoriatic Arthritis Alliance recommends trimming nails back to the point of firm attachment.

“This decreases the chance of accidentally snagging or ripping off detached portions of your nails,” explains Dr. Sutera. If nails are thick, keeping them shorter will also decrease the amount of buildup underneath the nails that that can cause pain and bruising.

Trim nails with a clipper or scissors

These tools provide a cleaner, quicker cut than a file. They also eliminate the back-and-forth motion of filing, which can weaken and traumatize nails. Clip toenails straight across to avoid ingrown toenails; trim fingernails straight across, then slightly round the corners while filing nails in one direction. To soften nails and make them easier to cut, soak them in warm water first for five to 10 minutes.

Sterilize your tools before every use

Inflamed skin is more susceptible to infection, so be sure to disinfect clippers, scissors, and glass nail files with an alcohol-soaked cotton ball before using them.

Leave your cuticles alone — unless you’re removing a hangnail

Pushing back or cutting cuticles or dissolving them with a cuticle remover can injure skin and set off a psoriasis flare. Another don’t: cleaning debris (actually, a buildup of keratin, the protein from underneath the nail) with a sharp object or nail brush. “Probing underneath the nails can cause puncture wounds and can encourage detachment of the nail,” says Dr. Sutera.

Soaking the affected nails in soapy warm water may be sufficient to remove the debris.

Buff nails as little as possible

Buffing can help hide mild pitting, but it should be done gently on the thickest part of the nail with a fine-grit file or buff block and only until the surface of the nail is smooth. Another option is to use a product that contains urea or a mild alpha-hydroxy acid like glycolic acid. These ingredients break down the protein nails are made of, which helps smooth them out.

Smooth skin safely

Very gentle use of pumice stones, foot files, and exfoliating scrubs is only to be done on intact skin that is thick and has no psoriatic lesions, says Dr. Sutera. “Instead, focus on DIY massage, soaking in warm water with gentle soap, essential oils, or Epsom salts.”

Avoid artificial nails

Fake nails may cover up nail problems, but they’re actually more likely to make them worse —especially when nails are long. This can increase stress and strain to your real nail, trigger the Koebner phenomenon, and worsen nail psoriasis.

Gel nails are also a no-no, according to Dr. Gohara, who says the physical and chemical insult can be “a recipe for disaster.”

Pick the right polish and polish remover

Polish can go a long way toward improving the appearance of nails, as well as provide a level of protection. A strengthening or ridge-filling base coat can help shore up weak or brittle nails. But some ingredients found in nail lacquer — for instance, formaldehyde and toluene — can cause contact dermatitis in some people with psoriasis, who have sensitive skin. To sidestep them, consider using “5-free” (or “7-free” or “10-free”) nail polish, which refers to products that don’t contain these types of ingredients. Dr. Sutera likes Dr.’s Remedy Enriched Nail Care products.

When it comes to polish removal, opt for a product that doesn’t contain acetone, a harsh solvent. Non-acetone removers are less drying (a plus for weaker nails) and gentler on sensitive skin.

Moisturize regularly

Psoriasis dries your skin and nails, and the uptick in hand washing during the pandemic can only exacerbate the problem. To lock in much-needed moisture, apply a thick cream or ointment every time you wash your hands. These products contain more oil than water-based lotions and are more effective at trapping water in the skin.

The upshot: “Nails that are moisturized can appear less brittle and overall healthier,” says Dr. Sutera. As a bonus, moisturizing will help your manicure last longer, since brittle nails chip more easily.

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7 Nail-Care Tips That Can Reduce Nail Psoriasis. American Academy of Dermatology. https://www.aad.org/public/diseases/psoriasis/skin-care/nail-care.

Interview with Mona Gohara, MD, associate clinical professor of dermatology at Yale School of Medicine in New Haven, Connecticut

Interview with Jacqueline Sutera, DPM, a podiatric surgeon in New York City

What Is Nail Psoriasis? Psoriasis and Psoriatic Arthritis Alliance. https://www.papaa.org/learn-about-psoriasis-and-psoriatic-arthritis/further-information/nail-psoriasis.

What Is Nail Psoriasis and How Can I Treat It? American Academy of Dermatology. https://www.aad.org/public/diseases/psoriasis/treatment/genitals/nails.