Understanding Nail Abnormalities: Psoriasis vs Fungus
Have you noticed spots, pitting or irregularities on your toenails and fingernails? Discoloration and nail deformities are commonly caused by fungal infections. However, other common nail conditions like psoriasis can also lead to similar unusual nail changes.
Determining whether you have a fungal nail infection vs nail psoriasis is important, as the underlying cause and recommended treatment options differ for each condition. Well explain how to distinguish between toenail fungus and fingernail psoriasis symptoms, causes and treatments.
Similarities Between Nail Fungus and Psoriasis
On the surface level, changes to the nails caused by fungal infections and psoriasis share common characteristics, making them difficult to visually distinguish. These include:
- Yellow, white or brown nail discoloration
- Nail plate thickening and irregular surface
- Pitting, lines or grooves on the nail
- Flaking, loosening or crumbling nail edges
- Nail separation from nail bed
Further medical evaluation is often required through lab tests or biopsy to determine the underlying trigger causing the nail deformity - either a fungal nail infection or nail psoriasis.
What Causes Fungal Nail Infections?
Toenail or fingernail fungus is typically caused by microscopic organisms called dermatophytes. In particular, the trichophyton rubrum and trichophyton mentagrophytes fungi species commonly infect nail beds. These infections cause inflammation and thickening under and around the nail.
Risk Factors for Developing Nail Fungus
Some factors that increase susceptibility to fungal nail infections include:- Excess moisture - from swimming, excessive sweating
- Walking barefoot in public areas like pools, gyms, showers
- Diabetes or reduced immunity illnesses
- Poor foot hygiene
- Minor nail or skin injuries
- Using public pedicure equipment
Toenails are more prone as they are confined in shoes with darkness and little airflow, allowing fungi to thrive. However, fingernails also frequently develop fungal infections.
What Triggers Nail Psoriasis?
Nail psoriasis is triggered by inflammation associated with psoriasis skin disease. Up to 50% of those with plaque psoriasis can experience nail changes like pitting, ridges and discoloration from psoriatic involvement under the nails.
Why Does Psoriasis Cause Nail Changes?
With psoriasis, the immune system overreacts and accelerates skin cell turnover, causing a buildup of cells on the skins outer layers. This excess skin production under the nails results in the following nail abnormalities:
- Large nail pits - from disrupted nail growth
- Yellow to brownish discoloration
- Reddish spots under nails - called salmon patches
- Thickened nails
- Detached or loose nails - called onycholysis
Those with psoriasis have a lifetime risk of 80-90% for nail involvement from inflammatory psoriatic disease activity in 10-15 years following initial skin psoriasis diagnosis.
Key Differences: Nail Psoriasis vs Fungus
Despite similar clinical nail presentations, distinguishing characteristics can help determine if nail psoriasis or a fungal nail infection is the culprit:
Associated Skin Findings
Psoriasis nails are almost always accompanied by typical raised, scaly psoriasis plaques on skin elsewhere like elbows, knees and scalp. Skin findings are typically NOT seen with isolated fungal infections.
Nail Bed Changes
Nail psoriasis shows pitting, lines, ridges and deformities of the nail bed before significant nail plate changes occur. Fungus begins with distal edge discoloration and thickening.
Nail Plate Appearance
Fungal infections cause yellow, streaky nails with white spots and overall nail plate thickening. Psoriasis nails retain a mostly smooth surface with dotted nail bed stippling and pits evident under the clear nail.
Presence of Collections
Build up of skin cells, pus and fluids under the nail called collections involving the cuticle and nail plate are classic for acute nail psoriasis flares but uncommon with fungal infections.
Pain and Discomfort
Nail psoriasis is often painful with throbbing and tenderness of the tissue around the nail. Fungal infections alone dont cause pain unless complicated by secondary bacterial infections.
Paying attention to these subtle distinguishing features can help guide accurate diagnosis and treatment. When in doubt, doctors can perform additional evaluation through microscopic exam or nail tissue biopsy.
How to Treat Fungal Nail Infections
If determined your nail condition stems from a fungal source, either oral or topical antifungal medications will likely be prescribed, including:- Ciclopirox solution
- Efinaconazole topical solution
- Tavaborole topical solution
- Terbinafine oral tablets
- Itraconazole oral capsules
Topical treatments applied directly to affected nails require daily application for 48 weeks, allowing new nail growth to push out the infected portion. Tablets taken by mouth also interrupt fungal cell production but can cause side effects like nausea or liver inflammation.
Over-the-counter topical creams containing undecylenic acid or tolnaftate may also suppress mild fungal nail infections when applied daily. Good nail hygiene and moisture control minimize recurrence risk once treated.
Treating Nail Psoriasis
Doctors aim to treat the inflammatory psoriasis disease process to prevent ongoing nail damage. Treatment options include:
- Corticosteroid injections near nail fold
- Anti-inflammatory ointments
- Oral medications methotrexate, biologics
- Light therapy
Controlling related skin psoriasis with medications to suppress the immune response helps resolve nail psoriasis secondary to the inflammatory disease. Keeping hands and feet moisturized also helps improve nail psoriasis.
Takeaway: Nail Psoriasis vs Fungus
Both toenail fungus and fingernail psoriasis can make nails discolored, brittle and malformed. Key indicators like skin findings, nail bed stippling and fluid buildup point to psoriasis, while fungal infections show plate thickening and streaky yellow discoloration.
Pay attention to subtle distinguishing features when evaluating your own nail abnormalities. Accurately identifying underlying trigger causes is crucial for successful treatment management between cases of nail psoriasis vs fungus.
FAQs
How can you tell the difference between nail fungus and psoriasis?
Key indicators of nail psoriasis include associated skin plaques, nail bed stippling and pits, red salmon patches under nails, fluid-filled collections, and nail pain. Fungal infections cause thick, streaky, crumbly yellow nails without other skin findings.
Can you have both nail fungus and psoriasis?
Yes, it's possible to develop a fungal nail infection independently that complicates existing nail psoriasis. The already abnormal psoriasis nails provide the perfect environment for fungi to thrive. Identifying both may alter treatment approach.
Is nail psoriasis painful?
Yes, nail psoriasis frequently causes a throbbing pain and tenderness of the tissues around the nail beds and tips. This pain helps distinguish psoriasis from fungal infections, which don't hurt unless complicated by a secondary bacterial co-infection.
How do you get rid of nail psoriasis?
Controlling related skin psoriasis is key to resolving the nail changes. Topical steroids, oral medications, injected medications and light therapy treat the immune-related disease. Moisturizing helps improve appearance as new, healthier nails grow out.
What is the fastest way to cure toenail fungus?
Oral antifungal tablets like terbinafine are the fastest approach, providing fungus cure rates of 60-80% in 3 months. Topical solutions take 48 weeks for infected nails to fully clear as new growth pushes out the old nail but avoid systemic side effects.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
Add Comment