From the Research
Psoriasis can be associated with several oral and nail manifestations, including pitting of nails, which is strongly associated with psoriasis, occurring in approximately 50-79% of patients with psoriasis and up to 80% of those with psoriatic arthritis, as reported in the most recent study 1.
Key Associations
- Gingival hyperplasia is not typically associated with psoriasis.
- Terry's nails are not a classic feature of psoriasis but are more commonly seen in liver disease, heart failure, and diabetes.
- Folliculitis is not a direct manifestation of psoriasis, though psoriasis treatments like biologics may increase susceptibility to folliculitis.
- Pitting of nails is a common manifestation, resulting from defective nail formation in the proximal matrix.
- Aphthous ulcers are not directly associated with psoriasis, though some research suggests patients with psoriasis may have a slightly higher prevalence of oral lesions.
Nail Changes in Psoriasis
- The most common nail changes in psoriasis include:
- Nail pitting
- Onycholysis (nail separation)
- Oil spots (salmon patches)
- Subungual hyperkeratosis
- These nail manifestations often correlate with disease severity and can significantly impact quality of life, sometimes requiring specific treatments beyond those used for skin lesions, as noted in 1 and supported by earlier studies like 2.
Considerations for Management
- Management of psoriasis must be individualized and may involve combinations of different medications and phototherapy, considering the severity of skin and nail manifestations, as discussed in 3 and 4.
- The association between nail involvement and the severity of skin lesions in psoriatic patients, as found in 2, highlights the importance of considering nail manifestations in the assessment and treatment of psoriasis.