Psoriasis is a chronic proliferative epidermal disease that affects 1-3% of world total population. Although it may develop at any time and any age, but usually seen in people at their late thirties. It is estimated that about 50% of patients with psoriasis will have some degree of nail involvement. The characteristic yellow-brown discoloration is seen in nail matrix or nail bed in most of the patients.
There is no consistently effective therapy for nail psoriasis. The goal of treatment is to improve the function and appearance of your nails. The nail will often improve coincidentally with remission of cutaneous lesion and will almost improve after systemic antimetabolite or immunomodulator therapy. Removal of subungual debris and application of corticosteriods under occlusion may be beneficial.
Small amount of triamcinolone injection into the nail bed at 2-3 weeks interval have shown about 75% improvement in patients with psoriasis. But this method is painful and there might be around 50% recurrence rate when treatment is stopped. For hypertrophic or dystrophic nails urea 40% ointment showed some beneficial effects. It has been reported that 1% 5-flurouracil solution ( fluroplex ) applied twice daily to nail might decrease the severity of involvement by 75% in two-third of patients within 3 to 6 months.
Sometimes in more than 25% of psoriatic patients there is associated fungal infection, so, antifungal medications might help improve the overall conditions.