British Skin Foundation - Psoriasis

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Psoriasis of the toenails

Postby Womble_Tomsk on Thu Feb 16, 2017 11:15 am

I had been diagnosed with psoriasis of the toenails about 10 years ago at the NHS hospital in London. I was prescribed Calcipotriol scalp solution but I am not sure if it really works. Psoriasis affects mostly just two of my toenails and they get layered and a bit discoloured too. Is there anything else I could try to treat this condition? Also, is it unusual to get psoriasis just on the toenails?
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Re: Psoriasis of the toenails

Postby Rickyhom on Thu Feb 16, 2017 2:03 pm

I have this on ALL my toenails, and tried everything!! I decided 6 months ago to have laser treatment on them because I believe I also have fungus on them. I have been having 1 session every 2 weeks but because my nails just don't grow upwards it has been difficult to see if this is going to sort them or not. One thing is definite and that is that the nails are not now growing outward the way they were so I don't have to constantly file them flat. There is now a narrow white coloured nail growth at the bottom so I live in hope.

There is a product called Onypso from a company online called Farmaline which is specifically for psoriasis nails and this also stops mine from growing outward but after 6 months of using this nail varnish type product daily there was no continual improvement to the look of the nails like I hoped there would be. I think mine are too far gone.

I have psoriasis on my feet and hands but at the moment it is very much under control and you would hardly notice it provided I keep the skin continually moistened. My moisturiser of choice at the moment is Aproderm which I get on prescription. It has no nasties in it. I also have been on the Vit K2/ Vit D3 and magnesium spray for about 2 years and this I believe is what has made the difference. I think I should say that I won't do doctors' medications only natural.
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Re: Psoriasis of the toenails

Postby Womble_Tomsk on Thu Feb 16, 2017 4:31 pm

Rickyhom wrote:I have this on ALL my toenails, and tried everything!! I decided 6 months ago to have laser treatment on them because I believe I also have fungus on them. I have been having 1 session every 2 weeks but because my nails just don't grow upwards it has been difficult to see if this is going to sort them or not. One thing is definite and that is that the nails are not now growing outward the way they were so I don't have to constantly file them flat. There is now a narrow white coloured nail growth at the bottom so I live in hope.

It is unfortunate that you have it on all of of your toenails, it must be very annoying! But you may or may not have fungus. My GP used to think I had fungus but treatments for it didn't help and then I got referral to the hospital where they took nail clippings, ruled out fungus and diagnosed me with psoriasis. Your condition sounds similar to mine. However I don't have psoriasis anywhere else on my body, only on my toenails.
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Re: Psoriasis of the toenails

Postby Dr Anton Alexandroff on Thu Feb 16, 2017 8:28 pm

Thank you. I am so sorry you have toenail psoriasis. Psoriasis can affect only nails (or only toenails, or only scalp) or only few toenails. Sometimes it is important to exclude fungal infection because both can look similar.

I am afraid nail psoriasis can be extremely difficult to treat! We had a part of dermatology conference devoted to this problem and all experts agreed that this can be a very challenging task.

Calciportiol /vitamin D preparations can be tried. Calcipotriol with steroid topical treatment (the latest iteration - Enstilar foam, an older version - dovobet) can be tried. Superpotent topical steroid can be tried for a limited period of time under medical supervision. Coal tar or dithranol topicals can be tried. Injection of nail beds with a steroid can be tried (painful! and requires repeated courses time to time).

Systemic treatments tend to work better. These include methotrexate, acitretin and fumaderm. They have to be initiated and monitored by a dermatologist and require baseline screening tests and close monitoring because they are very powerful treatments (see my other posts in this clinic about systemic treatments).

Arguably biologics systemic treatments are most effective to treat nail psoriasis (see my other posts in this clinic about systemic treatments).

I hope this is helpful.
With best wishes,

Dr Anton Alexandroff CCT(Dermatol) PhD FRCP(UK) FAAD FRSM
Consultant Dermatologist and Honorary Senior Lecturer
The British Skin Foundation Spokesperson
Member of The British Association of Dermatologists
Leicester Spire Hospital, Nuffield Health Cambridge and Leicester Hospitals, Bedford BMI Manor Hospital
http://www.alexandroff.org.uk
twitter: your_skin_dr
Dr Anton Alexandroff
Consultant Dermatologist, Honorary Senior Lecturer & BSF spokesperson - FRCP, CCT (Derm), PhD, FRSM, FAAD

http://www.talkhealthpartnership.com/online_clinics/experts/dr_anton_alexandroff.php
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Re: Psoriasis of the toenails

Postby Dr Anjali Mahto on Fri Feb 17, 2017 12:14 am

Thank you so much for taking the time to post.

There is no denying that nail psoriasis can be incredibly difficult to treat and topical therapies work poorly due to lack of adequate penetration where it is needed. Treatments that can help include oral immunosuppressive agents such as methotrexate or biological agents like etanercept. The potential risks need to be weighed up with benefits and this is a discussion to have with your treating dermatologist.

Best wishes,

Anjali
Dr Anjali Mahto
Consultant Dermatologist and British Skin Foundation spokesperson
http://www.talkhealthpartnership.com/online_clinics/experts/dr_anjali_mahto.php
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