Changes to your nails can be alarming and can definitely affect your quality of life. Two common conditions that cause changes to the fingernails and toenails are nail psoriasis and nail fungus.
Because both conditions can cause the nails to change color, thicken, and even change shape, it can be difficult to know which one you’re dealing with. This is because there are many overlapping symptoms that may lead to some confusion.
The purpose of this article is to clearly differentiate between nail psoriasis vs fungus. We will cover the causes, symptoms, diagnosis, treatment, and prevention for each condition.
Understanding the differences between these two common causes of nail problems is crucial for proper management and care.
Understanding the conditions
When your nails start to look different, it can be a little alarming. Are they infected? Are they just getting old? It’s a good idea to check in with a health professional to find out what’s going on.
Nail psoriasis
Nail psoriasis is a symptom of the autoimmune disease psoriasis. Psoriasis is a long-term inflammatory condition that is not contagious. About 40 to 50 percent of people who have psoriasis also experience it in their nails.
Nail fungus (onychomycosis)
Nail fungus is an infection caused by different kinds of fungi, like Trichophyton rubrum and Candida albicans. Nail fungus is contagious, so it’s important to take precautions if you’re around someone who has it.
What causes nail fungus and nail psoriasis?
The causes of nail psoriasis and nail fungus are very different.
What causes nail psoriasis?
Nail psoriasis results from a mix of factors, including your genes, the world around you, and how well your immune system is working. Stress, seasonal changes, and infections can be triggers that make nail psoriasis worse.
What causes nail fungus?
Nail fungus happens when tiny organisms, such as molds or yeasts, infect your nail. These organisms thrive in warm, moist places, so people who wear sweaty shoes all day or who frequent public pools or showers are more prone to getting nail fungus.
Nail fungus vs. psoriasis symptoms
It can be tricky to tell whether changes in your nails are due to psoriasis or fungus. Here’s a symptom-by-symptom guide to the differences.
Symptoms of nail psoriasis
- Nail pitting: You may see tiny depressions on the surface of the nail, from one to dozens.
- Nail thickening: The nail may be thicker than usual.
- Onycholysis: The nail may detach from the nail bed.
- Nail discoloration: The nail may turn yellow or brown.
- Subungual hyperkeratosis: A chalky substance may build up under the nail.
- Splinter hemorrhages: You might see tiny, dark lines under the nail.
- Leukonychia: White spots or lines may appear on the nails.
- Salmon patches: You might see something that looks like an oil drop under the nail.
Symptoms of nail fungus
- Nail thickening: The nail may be thicker than usual.
- Nail discoloration: The nail may turn yellow or brown.
- Brittleness: The nail may become brittle and crumble.
- Distorted nail shape: The nail may be an unusual shape.
- Subungual hyperkeratosis: Debris may build up under the nail.
- Foul odor: The nail may smell bad.
As you can see, there’s some overlap in the symptoms of nail fungus and nail psoriasis. But the presence of pitting, splinter hemorrhages, leukonychia, or salmon patches are more indicative of psoriasis than fungus.
What puts you at risk?
Nail fungus and nail psoriasis have different risk factors.
Risk factors for nail psoriasis
- Having psoriasis
- Having a family history of psoriasis
- Having psoriatic arthritis
- Experiencing environmental triggers such as stress, skin injury, or infection
Risk factors for nail fungus
- Being over the age of 60
- Having diabetes
- Having a weakened immune system
- Having poor blood circulation
- Experiencing nail injuries
- Having athlete’s foot
- Wearing shoes that don’t allow your feet to breathe
Some of these risk factors, such as age and family history, are out of your control. However, there are steps you can take to lower your risk for both conditions.
How do doctors diagnose nail psoriasis and nail fungus?
If you’re worried about the appearance of your nails, it’s important to see a doctor for a correct diagnosis. While the symptoms of nail psoriasis and nail fungus can overlap, the treatments are very different. You don’t want to waste time and money on the wrong approach.
Diagnosing nail psoriasis
To diagnose nail psoriasis, a doctor will:
- Examine your nails and skin.
- Ask about other symptoms of psoriasis.
- Try to rule out other conditions, such as nail fungus.
- In some cases, perform a nail biopsy, which involves taking a small sample of your nail for testing.
Diagnosing nail fungus
To diagnose nail fungus, a doctor will:
- Examine your nails.
- Take a nail clipping or scraping for laboratory testing. Technicians will then examine the sample under a microscope and perform a fungal culture to identify the specific fungus causing the infection.
- Use dermoscopy, a special magnifying tool, to get a better view of the nail and aid in diagnosis.
Nail Fungus vs. Nail Psoriasis Treatment
Fungal infections and psoriasis are very different conditions, so it makes sense that they need very different approaches to treatment. Here’s a look at some of the treatments your doctor might recommend.
Treatment for Nail Psoriasis
Nail psoriasis can be tough to treat. Mild symptoms may respond to topical treatments, but more severe cases may require systemic medications that affect the whole body. Here are some options:
- Topical corticosteroids. These medications can reduce inflammation and slow down the overproduction of skin cells.
- Topical vitamin D analogs (calcitriol). These medications can also slow down skin cell production and reduce inflammation.
- Topical retinoids. These medications can help to normalize skin cell growth.
- Intralesional corticosteroid injections. Injections of corticosteroids directly into the nail bed can reduce inflammation and improve nail appearance.
- Systemic treatments. For severe cases of nail psoriasis, your doctor may prescribe medications that affect the entire body, such as methotrexate or biologics. These medications are often used when psoriasis affects other parts of the body, too.
Treatment for Nail Fungus
The goal of treatment for nail fungus is to kill the fungus and allow healthy nail to grow back. Here are some options:
- Topical antifungal medications. These medications are applied directly to the nail and surrounding skin, but it’s important to rule out other conditions such as green nail syndrome. Examples of topical treatments include ciclopirox and efinaconazole.
- Oral antifungal medications. These medications are taken by mouth and are generally more effective than topical medications, but they can have potential side effects. Examples include terbinafine and itraconazole.
- Laser therapy. This treatment uses laser energy to kill the fungus.
- Surgical nail removal. In severe cases, your doctor may recommend removing the nail surgically. This is often combined with antifungal medications to prevent the fungus from returning.
Home remedies and prevention
It’s best to see a doctor if you think you have a nail condition. They can give you a diagnosis and medical treatments. But here are some things you can try at home:
Home remedies
- For nail fungus: Some people use tea tree oil or vinegar soaks to treat nail fungus. Keep in mind that scientific evidence is mixed, and these remedies may not work for everyone.
- Good nail hygiene: Keeping your nails clean and trimmed can help prevent both psoriasis and fungus.
Prevention
- For nail psoriasis: Manage your psoriasis symptoms with your doctor’s help and try to avoid triggers that make your psoriasis worse.
- For nail fungus: Keep your nails clean and dry, wear shoes that let your feet breathe, avoid walking barefoot in public places (especially locker rooms and showers), and don’t share nail clippers with anyone.
Frequently Asked Questions
How I cured my nail psoriasis
Unfortunately, there’s no definitive “cure” for nail psoriasis, but various treatments can help manage symptoms. These include topical medications like corticosteroids, vitamin D analogs, or retinoids. In more severe cases, systemic medications or light therapy might be recommended by a dermatologist. Individual results can vary widely.
What autoimmune disease causes nail fungus?
Nail fungus itself isn’t caused by an autoimmune disease. However, autoimmune diseases like psoriasis can cause nail changes that may resemble a fungal infection, leading to confusion. The key is that the nail changes in psoriasis are due to inflammation, not a fungal organism.
What can be mistaken as nail fungus?
Several conditions can mimic nail fungus, including nail psoriasis, trauma to the nail, lichen planus, eczema, and certain bacterial infections. A proper diagnosis from a healthcare professional is crucial to ensure appropriate treatment.
What mimics nail psoriasis?
Nail fungus is a common condition that often mimics nail psoriasis. Other conditions that can look like nail psoriasis include onychomycosis (fungal infection), nail trauma, and even certain nutritional deficiencies. The presence of pitting, oil spots, or nail separation can help distinguish psoriasis from other conditions, but a dermatologist’s evaluation is always best.
What are 3 symptoms of psoriasis?
Three common symptoms of psoriasis include raised, inflamed plaques of skin (often red with silvery scales), nail changes such as pitting, thickening, or separation from the nail bed, and joint pain or stiffness (psoriatic arthritis).
Summary
Psoriasis of the nails and nail fungus can look alike, but they have different causes. Nail psoriasis is caused by an autoimmune condition, and nail fungus is caused by an infection.
It’s important to get a diagnosis from a healthcare professional if you think you have either of these conditions. Treating yourself based only on appearance can lead to complications or ineffective care.
Nail problems can take a long time to resolve, so be patient. Nails grow slowly, and treatment for either psoriasis or fungus can take time to work. Talk with your doctor about your concerns and keep them informed about your progress.