Nail Psoriasis: A Narrative Review of Manifestations, Diagnosis, and Management

Abstract

Psoriasis is a common, chronic inflammatory dermatosis, and patients with psoriasis often develop nail involvement. It is estimated that up to 90% of patients experience nail lesions at least once in their lifetime. Nail psoriasis (NP) occurs when psoriatic inflammation affects the nail matrix, nail bed, or both. The clinical manifestations of NP vary depending on the location and severity of the inflammation. Common signs include pitting, splinter hemorrhages, salmon patches, and distal onycholysis. Although cutaneous psoriasis is considered more severe in individuals with nail involvement, there is no clear relationship between the duration, severity, and clinical presentations of cutaneous psoriasis and NP patterns. NP is notable for an increased prevalence of arthritis among patients and is considered a significant clinical burden due to its association with arthritis and its slow or poor response to many therapeutic agents. Effective reassurance and patient education are essential components of NP management. This review summarizes clinical manifestations and diagnostic and therapeutic strategies for NP.