Living With Psoriatic Nails

Good Day Everyone,

A quick disclaimer to say that I am not a medical professional and that you should not make any changes to the way you look after your psoriatic nails without discussing it with your doctor first.  This is simply my personal experience of living with psoriatic nails.

I know I'm a bit out of sorts at the moment with my Living With blog posts due to my recent absence but I really want to continue with this little series of living with my chronic health issues. Having covered life with migraines, body and scalp psoriasis, today I wanted to talk about living with psoriatic nails which I have had for over three years. I was in two minds about whether to include a photo of my nails in this post as I didn't want to gross people out but after seeking a few second opinions the consensus was that what I'm about to show you isn't that bad to look at. If you do get grossed out easily then take this paragraph as a warning that photos will be at the bottom of this post so if you'd rather not see my unattractive nails then don't go to the end of this post. You've been warned!

A few months after I was diagnosed with psoriatic arthritis (PsA) I noticed a white-ish ripple like discolouration on the nail of one of my arthritic fingers. It wasn’t on top of the nail (as I couldn’t feel it) but more like part of the nail itself or at times looked like it was underneath the nail. Over the coming weeks the ripple got larger and the natural white tip of my nail started to expand down the nail so that the top half was now completely white with the bottom half still the natural pink colour.

I had read about people with PsA having a higher likelihood, than those suffering from psoriasis alone, of developing psoriatic nails so it didn’t come as a complete shock. However, as time progressed I noticed that another nail was becoming psoriatic but unlike the first nail, the finger of this particular nail was not arthritic. This confused me a little as in my head I had associated the arthritic finger with later going onto develop the psoriatic nail. A few weeks later the finger that was not arthritic but had the psoriatic nail did become arthritic. So I thought perhaps the psoriatic nail was some sort of ‘warning’ sign that the finger would go on to develop arthritis. But I was wrong!

In the coming months and years I quickly realised that there was no correlation between the psoriatic nails and the arthritic fingers, and nor did one act as a warning sign of the other. Currently all the nails on my left hand are psoriatic but I only have arthritis in two of the fingers. On my right hand, two nails are psoriatic but only one of those belongs to an arthritic finger.

As well as the white-ish discolouration, my psoriatic nails also developed a whole host of other issues;

• The nails all developed a lot of ridges in them.
• The  nail tips became really thick and it's like there was some sort of skin growing under parts of the nail tip.
• The nails developed these tiny little holes in them, like little pits and my main concern with this was the risk of the nail getting infected, but that has never happened.
• The corners of nails with a lot of white discolouration would lift up and grow upwards and outwards making them more likely to break or catch on things.
• Some of the nails started to lift up from the finger / nail bed itself, especially the ones where the white tip had spread further down the nail. This was most concerning as I was worried about the nail completely lifting up from my finger and just dangling from the cuticle. Worst still, I started to have nightmares about waking up to find that there was no nail on my finger. Luckily this has never happened and the nightmares stopped as time went on and I got used to life with psoriatic nails.
• The psoriatic nails were also more prone to breakages and became quite brittle and dry. As the tiny holes would grow out the jagged edge they created would catch on my clothes, sofa, hair etc. Sometimes if the hole was at the bottom of the nail but close to the side, it would cause a bit of a horizontal crack in the nail which was almost impossible to file down and I would have to wait weeks for it to grow to the tip so I could cut it down and file it.

On one of my follow up visits to my rheumatologist (doctor who treats arthritis) I asked him if there was anything that could be done to treat my psoriatic nails because as well as the physical damage and pain they sometimes caused, I was also very embarrassed and self conscious about them. It was bad enough that I had ‘sausage' fingers due to the arthritic swelling but to have unpleasant looking nails was quite tough as it's hard to hide your nails from people. I used to be worried that people would think that I had some kind of contagious disease and be revolted by them. I quickly became very good at keeping my fingers away from people’s view by folding them under crossed arms, resting my chin on one hand so that the fingers and nails bent towards me, putting my hands in between my crossed legs or hiding them with the way I held papers / books etc.

My rheumatologist told me that some of the stronger treatments for arthritis also have a beneficial effect on psoriatic nails but I wasn’t and didn’t want to go onto the stronger medication until I absolutely had to because of the side effects they cause. He told me that there weren’t really any treatments specifically for psoriatic nails and those that were used by doctors often had the potential for terrible side effects so it was always about weighing up the risk-benefit. He also mentioned that some people have had steroidal injections in their nails but he said that he could guarantee that if I had this injection in one nail, I would not have it in another as the pain is sooo bad. Well, with the pathetic pain threshold that I have, that was enough to put me off that option!!! I was told that if I ever did get a fungal or bacterial infection then I would be prescribed a treatment for that but in the meantime I should keep my nails clean, dry and short.

As I’ve lived with my psoriatic nails I have learnt little ways of protecting them as much as I can and minimising further damage;

• I keep them as dry as possible because I always worry about the risk of a fungal or bacterial infection if they’re constantly getting wet.
• I always wear gloves when washing the dishes or clothes to keep them dry.
• I cut them as short as I possibly can as the longer they are the more likely they are to break or catch on things.
• I always file away sharp edges as best I can.
• I massage natural oil (like argan, coconut, almond or olive oil) on and all around all of my nails just before I shower as a way of providing them with some sort of a protective layer from the water.
• I also massage natural oil into my nails before bed because I feel like I’m feeding them goodness and it helps calm the brittleness and dryness thus reducing breakages and cracks.

I do very gently buff the ridges on the nail surface because I just feel happier when my nails feel smooth and I keep the corners of the nail tips well rounded, again to minimise the risk of them catching on things. I don’t tend to wear nail polishes as I’m conscious about the fact that I’m applying a layer of chemicals on nails with pits and holes in them. I also don’t cut or push my cuticles back at all for fear of weakening the nail and it falling off!!!

Over time I have come to accept my sausage fingers and psoriatic nails to the point that I don’t really hide them from people anymore. If people want to judge me or give me funny looks because of my fingers and nails then that’s up to them. I may occasionally give them a hard stare back if I see someone who is very obviously staring at them :o) Sometimes people will just ask me what happened to my fingers in which case I’m happy to explain it to them. At the end of the day whilst it does make me sad that I don’t have very pretty, feminine nails and hands, I just remind myself that at least I still have nails on my fingers and fingers on my hand – that is still a lot to be grateful for and happy about :o)

Love Sheen xxx