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Psoriasis - Nail and Distal Digit
See also in: Overview,Anogenital,Hair and Scalp
Other Resources UpToDate PubMed

Psoriasis - Nail and Distal Digit

See also in: Overview,Anogenital,Hair and Scalp
Contributors: Shari Lipner MD, PhD, Vivian Wong MD, PhD, Jeffrey M. Cohen MD, Susan Burgin MD
Other Resources UpToDate PubMed


Psoriasis is a disorder of skin hyperproliferation that commonly involves the nail unit. Approximately 80%-90% of patients with psoriasis display nail manifestations at some point in their lifetime. The manifestations of psoriasis may be limited exclusively to the nails in up to 10% of patients. Nail psoriasis has a significant effect on quality of life and is associated with higher risk of severe skin disease. Furthermore, nail involvement with psoriasis is a risk factor for developing psoriatic arthritis.

The most common nail findings in psoriasis are pitting, nail plate yellowing, onycholysis, subungual hyperkeratosis, splinter hemorrhages, and "oil spots." Psoriasis may also involve the nail folds in the form of swelling and chronic paronychia. Toenail findings are less frequent than psoriatic changes in the fingernails. When they do occur, subungual hyperkeratosis and yellow discoloration of the nail plate are the predominant findings.

Pediatric patient considerations:
Nail psoriasis in children is associated with more severe disease in most studies. It may be more common in boys than girls. The prevalence of nail psoriasis in children is 15%-19%. Furthermore, psoriasis is believed to be the cause of 7%-40% of all nail dystrophies seen in children.


L40.0 – Psoriasis vulgaris

9014002 – Psoriasis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Onychomycosis
  • Reactive arthritis (Reiter syndrome)
  • Lichen planus
  • Alopecia areata – Pits are generally more superficial and regular.
  • Pachyonychia congenita
  • Pityriasis rubra pilaris
  • Idiopathic Trachyonychia
  • Other causes of Onycholysis (eg, autoimmune diseases, medications, trauma)
  • Atopic dermatitis – If there is eczema that involves the proximal nail folds, abnormalities in the nails may be seen, including coarse pits and nail dystrophy.

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:11/20/2023
Last Updated:11/21/2023
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Patient Information for Psoriasis - Nail and Distal Digit
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Psoriasis - Nail and Distal Digit
See also in: Overview,Anogenital,Hair and Scalp
A medical illustration showing key findings of Psoriasis : Erythroderma, Extensor distribution, Nail pits, Scalp, Subungual hyperkeratosis, Onycholysis
Clinical image of Psoriasis - imageId=329024. Click to open in gallery.  caption: 'Well-demarcated annular scaly papules and plaques with erythema on the back.'
Well-demarcated annular scaly papules and plaques with erythema on the back.
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