Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Usually, people who have nail psoriasis also have skin symptoms, too. If you have psoriasis of the nails but do not have skin symptoms, the condition may be difficult for your doctor to diagnose. It is important to inform your doctor if you have a family history of psoriasis.
The nail area is made up of a nail plate, nail bed, hyponychium, nail matrix, nail folds, cuticle, anchoring portion, and ends of the finger bones. You can see each of these structures in images 1-2.
If you have psoriasis of the nails, you might notice the following signs:
Clear yellow-red nail discoloring that looks like a drop of blood or oil under the nail plate: This is known as an oil drop or a salmon patch and is a sign of nail psoriasis.
Little pits in your nails or pitting of the nail matrix. Pits develop when cells are lost from the nail's surface.
Lines going across the nails (side to side rather than root to tip): These are medically known as Beau lines of the nail.
Areas of white on your nail plate, otherwise known as leukonychia or midmatrix
Thickening of the skin under your nail: Your doctor may call this subungual hyperkeratosis. This can lead to loosening of the nail.
Loosening of the nail: This is medically referred to as onycholysis of the nail bed and nail hyponychium. Your nail may develop a white area where it is separated from the skin underneath your nail. It usually starts at the tip of the nail and extends toward the root. The nail bed (skin under your nail) may become infected.
Crumbling of the nail: The nail weakens because the underlying structures are not healthy.
Tiny black lines in your nail in tip-to-cuticle direction: These are called splinter hemorrhages or dilated tortuous capillaries in the dermal papillae. This occurs when the tiny capillaries in the tip of your fingers bleed between the nail and the skin under the nail.
Redness of the pale arched area at the bottom of your nail: This is known as a spotted lunula. It occurs when the capillaries under
the nail are congested.
Arthritis of the fingers with nail changes: The nails are affected in 53%-86% of people who have psoriatic arthritis.
Nail psoriasis can also occur together with fungal infections of the nail (onychomycosis) and inflammation of the skin around the edges of
the nail (paronychia).