Psoriatic Arthritis Nail Care
Question:
I’ve been diagnosed with Reactive Arthritis (Reiter’s) and the arthritis presents as psoriatic. I have major problems with finger and toe-nail deformation, including build-up of dead skin under the nail beds as the nails seperate. Does anyone have any recommendations for nail care? My doctor is usually unresponsive to my concerns over this, although not to other more serious elements of the disease. It may be a minor part of the whole picture but from a self-esteem perspective it’s terrible.
Response:
I had similar nail problems. The original diagnosis was nail fungus, and the topicals (Spectrazole and Oxistat) didn’t appear to affect the condition, although one never knows whether it might have gotten worse without them. The second diagnosis was Ps, and the prescriptions were Dovonex (calcipotriene) and Ultravate(halobetasol proprionate). These made a difference within a couple of weeks, and after several months, I have nearly normal nails. The meds are outrageously expensive (>$50 US per ounce), but it is nice having nails again. Never even thought about them until they went south; then I tried to pick up a couple of small objects and realized the importance of thumbnails. From reading this and other groups, I understand that individual response varies; these meds may not work for you. Good luck. arjay – Hide quoted text — Show quoted text – > I’ve been diagnosed with Reactive Arthritis (Reiter’s) and > the arthritis presents as psoriatic. I have major problems > with finger and toe-nail deformation, including build-up of > dead skin under the nail beds as the nails seperate. Does > anyone have any recommendations for nail care? My doctor is > usually unresponsive to my concerns over this, although not > to other more serious elements of the disease. It may be a > minor part of the whole picture but from a self-esteem > perspective it’s terrible.
Response:
Hi, Joaquin… and welcome to the group! I have psoriatic arthritis (PA) as well as psoriasis (Ps) and can sympathize with your problem. First of all, I hope the doctor who is caring for your arthritis is a rheumatologist. In addition, for the nail problems (and any other skin manifestations you may have), you probably should also have a good dermatologist. Now to the ways to help Ps of the nails. In my own case, I find it helps the most to protect the nails from the slightest injury. Although this may sound a bit ridiculous, the nails with psoriasis will tend to respond to the slightest of injury with formation of plaques under the nail, which causes the deformity of the nail a separation from the nail bed that you describe. To protect the nails from these perceived injuries, I clip them very, very short, especially anywhere they are deforming. I try to avoid using the nails as tools, which means don’t pick up coins or credit cards using the nails (slide them to the table edge into your palm instead). Don’t open packages or envelopes using your nails. Don’t peel stickers or tape using your nails. I also use Eucerin moisturizing creme (original formula, thick and sticky in the tub) after bathing and, if the nails are particularly bad, also before bed. Make sure your shoes don’t rub against the nails of your toes, especially if they are even slightly longer. The minute my nails begin to rub, I have to clip them or they start hurting. There are more drastic treatments if your nails become truly painful and are not responsive to the usual treatments, but you should hold off on them until you try easier and safer things. If it comes to that, there are topical corticosteroid cremes that may help massaged into the cuticle for a period of time. An extremely painful and not always successful treatment is a form of injections directly into the nail beds… not something I would ever do. And the final answer if necessary is to surgically remove the nail, something that I understand is not as bad as it sounds from the point of view of how it looks, as there appears to be a sort of indentation in the nail shape that remains. The following newsgroup will have many more people with Ps and experience along these lines for you: alt.support.skin-diseases.psoriasis You might also try: http://www.psoriasis.org/ which is the Natl Psoriasis Foundation, a very good group with excellent quality information on their website. Another good site is: http://www.psorheads.com This one is very new, but the people posting there are good folks with lots of collective experience to share. And this one also has excellent information: http://w1.2380.telia.com/~u238000263/flaker/docs/ I shall also add a reprint of a post on the topic from the newsgroup above that may be helpful (hope it isn’t too long!). The poster is a practicing and very experienced dermatologist: Nails are notoriously difficult to treat. I have found dovonex helpful, applied to the top of the nail, and around it, not pushed under. The following is from an old post by Dr. Joe, a respectable dermatologist who posts here occasionally. Perhaps you will find it helpful. Also, you might search the archives yourself for more discussions of nails at: http://www.pinch.com/skinny?deja=nails Amy Dearest forum members, I have recently received a very interesting question about a troubling problem, nail psoriasis. I decided to put a few thoughts down, explaining a few concepts, in order to help, if I could. Nail Psoriasis Nails are MUCH tougher than almost any other psoriasis lesions. It is thought that nail psoriasis lesions result from an actual psoriasis lesion under the nail, in the area where it separates. It is also thought that this is largely a manifestation of the Koebner phenomenon, that peculiar reaction of certain skin conditions to trauma on the skin surface. For this reason, one of the chief modes of therapy involves close trimming of the nails, so almost no free, white edge remains. The second premise in the treatment of nail psoriasis which works fairly well, but of course not perfectly, is to refrain from using these magnificent little tools (which fingernails are, actually), AS tools. This means that, for instance, you should SLIDE a coin off the edge of a surface, rather than the usual method of picking it up, which is to "finger nail pry" it off the table top. Every usage of nails in this manner, as tools, adds to the cumulative weight of trauma resultant in aggravation of the psoriatic lesion beneath the nail. Also, it is thought that the "pits" in nail psoriasis, which are so common, are the visible expression of actual tiny psoriasis lesions in the MATRIX of the nail — that blue/pink semilunar area we know as the "lunula." In fact, sequential biopsies have traced out those pits to such lesions. Treatment of pitting and "distal onycholysis," as the undermining of the free edge is called, is extraordinarily difficult. We generally like to avoid internal agents for treatment of psoriasis if possible, but they do tend to help. Still, avoiding using the nails as "tools" is the best approach. We have tried topicals, topical steroids under plastic occlusion, injection of steroids around the nail (painful!!), various light therapies, and none of them are as effective as we’d like. Usage of high powered steroids under plastic occlusion have even been noted to cause partial resorption of the distal digit (the bone at the end of the finger). I realize I haven’t given you much positive in terms of treatment. That will definitively await a cure of this condition. But in the meantime, treating your nails gently and keeping the free edge short will help some. Thanks for a great question. I wish I had a better answer. My best, Dr. Joe Best regards,
Response:
> I’ve been diagnosed with Reactive Arthritis (Reiter’s) and > the arthritis presents as psoriatic. I have major problems > with finger and toe-nail deformation, including build-up of > dead skin under the nail beds as the nails seperate. Does > anyone have any recommendations for nail care? My doctor is > usually unresponsive to my concerns over this, although not > to other more serious elements of the disease. It may be a > minor part of the whole picture but from a self-esteem > perspective it’s terrible.
As a person who went through high school with heavy scalp psoriasis, I know it can be tough. My nails are a wreck these days, but I just remind myself that at least I’m not back there in high school. A long time ago I learned that if I allowed my self-esteem to be dictated by my appearance then I was doomed. I realize that "learn to love it" probably isn’t what you were hoping to hear, but just give your Reiters a little time to get rolling and before long you’ll see that your fingernails are the least of your troubles… — Nathan Engle Shop Steward Electron Juggler’s Guild, Local #1 "Some Assembly Required"
Response:
>I’ve been diagnosed with Reactive Arthritis (Reiter’s) and >the arthritis presents as psoriatic. I have major problems >with finger and toe-nail deformation, including build-up of >dead skin under the nail beds as the nails seperate.
I don’t have personal experience in this area but it sounds like you have the skin and nail problems that are more psoriatic related. We have many psoriactic netlinks at: http://arthritis.about.com/msub10.htm Rick http://arthritis.about.com
Response:
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