Is it Nail Fungus or Psoriasis?

What Are They?

Nail Fungus and Psoriasis of the Nail are sometimes confused with one other, causing disappointment when treatments for one don’t work for the other.  Even with today’s technology and with the easy access to plentiful information, most people are not medical experts. Just because someone can look up a few symptoms on the Internet does not mean that he has the expertise or experience necessary in order to make a proper diagnosis. Doctors and other medical professionals still have problems diagnosing a host of different illnesses and conditions so an expert opinion should always be sought out whenever the case may warrant it.

Part of this problem is the fact that so many different diseases and medical issues can present themselves with similar symptoms and it takes a very skilled and trained eye to spot the difference. A good example of this is onychomycosis and psoriasis of the nail. Onychomycosis is a fungal infection which presents itself in the toenails as well as the fingernails. It comes in several different variants and can be caused by multiple types of dermatophyte fungi. One of the variants of nail fungus is known as white superficial onychomycosis and it shows up with similar symptoms to psoriasis of the nail. Psoriasis is a chronic skin disease which causes patches of red skin which also has silvery scales to appear on areas of the body such as the scald, torso, knees and elbows. However, it can also appear on the finger and toenails, resembling onychomycosis.

This similarity between the two diseases can cause some people to seek treatment or to purchase medication immediately without consulting with an expert and they can accidentally purchase the wrong one. While it is true that people with onychomycosis should start to use some sort of nail fungus treatment as soon as possible because it can take some time for it to have a full recovery, it is also important to be sure regarding the type of disease a person has before any form of treatment begins.

 nail-fungus-WSO-fixafungus  nail-psoriasis-fixafungus

Figure 1. White Superficial Onychomycosis.

Figure 2. Nail Psoriasis.

According to the American Academy of Dermatology and the National Psoriasis Foundation as many as half of the people that have skin psoriasis can also have nail psoriasis. However, only about 5% of the people that have nail psoriasis do not have the skin affliction as well[1]. That means that the potential for a misdiagnosis between the two similar conditions is possible only in 5% of the people that already suffer from nail psoriasis. However, medical records show that this kind of misdiagnosis happens on a regular basis for one of two reasons: either the patient does not consult with a dermatology expert or other areas of the body are not checked during consultation.

 The Symptoms of the Two

The main reason for the confusion caused between the two conditions is the fact that they both turn the nail white. That means that people that rush to a conclusion or simply those that are not aware of one of the conditions can mistake one for the other. However, they both present themselves with a lot more symptoms which can be used to make a clear distinction between the two.

The aspect of the conditions might be similar to the layman, but they should not be able to fool a trained professional. White onychomycosis causes the nails to look dystrophic (damaged) with subungual hyperkeratosis or scaling. At the same time, psoriasis can also makes the nails appear dystrophic but with pitting on the surface. While both ailments can be found in both finger and toenails, onychomycosis is usually more common in toes since it is a fungus which thrives in a wet or damp environment while psoriasis of the nail affects fingers more commonly. The dystrophy of the nails is a lot more pronounced in the case of onychomycosis which can lead to more discomfort and even pain. On the other hand, psoriasis can cause the nail to suffer from discoloration which comes in the form of oil spots. Lastly, the most telling symptom of each disease is the way in which it can affect other areas. Most cases of nail psoriasis also come with skin psoriasis on other parts of the body which causes silver scales to develop. At the same time, the toenail fungal infection which causes onychomycosis can spread to other areas such as the scalp or the groin.

There has been a study conducted which aimed to determine whether there is a link between the two illnesses. The study encompassed 561 patients that suffered from psoriasis who had their nails examined. Out of these, the number of people with onychomycosis was found to be 1.56 times higher than the average considering the age and gender of the study subjects[2].

Treatment of the Two Conditions

 Although the symptoms of the two diseases might seem similar at times, even enough to fool most people into making a wrong diagnosis, the treatments for them differ wildly. Onychomycosis can be treated with various different medications. Pills which are taken orally are the most common such as Lamisil. However, they require a long treatment period and can come with a lot of unpleasant side effects and even dangerous ones such as liver damage. For that reason, many people prefer to stay away from them. New advances in technology have allowed lasers to be used in order to treat this condition to somewhat mixed results. While it does prove to be efficient at dealing with fungal infections, its high expense and the high chance for relapse recommend more studies to be performed before pursuing that option.

The easiest and least expensive course of action for treating nail fungus involves using various topical ointments or lacquers which can be applied directly to the nail. It is important when using a topical treatment to make sure that the antifungal, like Fungicillin™ is able to eliminate the infection by multiple pathways or the fungus can become resistant to a single drug.  Even more important is that the product has incorporated a strong penetration enhancer like Keratrate™ that is able assist the antifungal in penetrating the nail plate to reach the affected area. Otherwise, the topical ointment is simply dispersed and while some may be absorbed into the skin surrounding the infected toenail, most of the medication will not have effect.

Psoriasis of the nail currently does not have a definitive cure which will eliminate the problem forever. The current treatments seek to improve the appearance as well as the function of the affected nails. These can include injections of steroids which are done directly into the nail bed, while some cases can benefit from systemic therapy using methotrexate or systemic retinoids[3]. These are all complemented by using ointments and creams which contain vitamins A or D and also contribute towards improving the overall appearance of the nails.

In more extreme cases of nail psoriasis a doctor can have the affected nail removed either surgically or chemically. They are both painless, as the surgical option uses a local anesthetic and the chemical alternative uses a lotion which causes the nail to fall off by itself without any bleeding in around 7 days. Additionally, a therapy known as PUVA has also shown to have good results. It uses a combination of exposure to ultraviolet lights together with prescription drugs in order to drastically reduce the effect which the disease has on the nail. The type of treatment used will differ from case to case depending on whether the patient also has signs of psoriasis in other areas of the body.

 


[1] Alai, N. Cole, G. Shiel, W. “Psoriasis”. MedicineNet

[2] Gupta AK et. al. “A Higher Prevalence of Onychomycosis in Psoriatics Compared with Non-Psoriatics”. Journal Watch Dermatology.

[3] Stollery, N. “Onychomycosis VS Nail Psoriasis” GPOnline

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