Nail Psoriasis

Understanding how psoriasis can affect your fingernails and toenails, and where to find support.

If your nails have started to change, you may be wondering what is going on. Pits, ridges, colour changes or a nail that is lifting away can be worrying, and they can be sore or get in the way of everyday jobs too. You are not alone, and you are not imagining it.

This page explains what nail psoriasis is, what it can look like, how it differs from a fungal nail infection, how it links to psoriatic arthritis and how the NHS approaches it across the UK. If you would like the wider picture first, start with What is Psoriatic Disease.

We are not medically trained. Psoriatic Disease UK is a patient-led charity. We share clear information to help you feel more confident talking to your GP or specialist. We cannot diagnose you or give medical advice.

What is nail psoriasis

Nail psoriasis is psoriasis that affects the nails. It is the same condition as psoriasis on the skin, appearing on the nail instead of, or in addition to, the skin. It can affect fingernails, toenails or both.

It is common. The British Association of Dermatologists and nidirect both say that around half of people with psoriasis have changes in their nails. You can read more about psoriasis in Symptoms of Psoriasis.

Like psoriasis on the skin, nail psoriasis is not contagious. You cannot catch it or pass it on, and it is not caused by anything you did.

What does it look like and feel like?

Nail psoriasis looks different from person to person, and one nail can be affected more than another. NHS.UK, NHS Inform and the British Association of Dermatologists describe changes such as:

• tiny dents or pits in the surface of the nail

• ridges across or along the nail

• patches of colour change, including yellow or pinkish areas under the nail

• a nail that becomes thicker

• a nail that lifts or separates from the nail bed

• a nail that becomes crumbly, in more severe cases

Some people have only one or two small changes. Others have several nails affected.

Nail changes are not only about how they look. The British Association of Dermatologists says they can be painful and can make everyday tasks harder, such as doing up buttons, picking up small things, or getting dressed without a nail catching on clothes. If that sounds like you, it is worth telling your GP. It counts.

Is it the same as a fungal nail infection?

No, but the two can look alike, which is why nail changes are worth getting looked at.

A fungal nail infection is caused by a fungus. NHS.UK says it usually affects toenails, though fingernails can be affected too, and that it often starts at the edge of the nail before spreading, making the nail thicker, white or yellow, brittle or crumbly. Unlike psoriasis, a fungal infection can spread to other people and to other nails.

Both can make a nail thick, discoloured and crumbly, so it can be hard to tell them apart by eye. NHS Inform and nidirect also say that people with psoriasis are more likely to get a fungal nail infection, so having one does not rule out the other.

We cannot tell you which one you have. A GP can look at your nails, and NHS.UK says that a GP may take a small sample of a nail for testing before recommending treatments for a fungal infection. You can read the NHS pages on fungal nail infection for more.

Nails can also change for other reasons. NHS.UK says injuries, nail biting, harsh chemicals, and other health conditions can all play a part, and that small dents or pits can be a sign of nail psoriasis, eczema or alopecia. If a nail has changed and you do not know why, NHS.UK says to see a GP.

Can you have nail psoriasis without skin psoriasis?

Yes, though it is less usual. The British Association of Dermatologists says that for a small number of people, psoriasis first shows up as nail changes only. For most people, skin psoriasis comes first, and nail changes tend to appear later, sometimes a few years afterwards.

If you have nail changes and no skin patches, it is still worth speaking to your GP. Our page on Getting a Diagnosis of Psoriatic Disease explains what to expect.

Does nail psoriasis mean psoriatic arthritis?

This is one of the questions people worry about most, so we will take it carefully.

Psoriatic arthritis is a long-term condition that affects the joints. Some people with psoriasis develop it. Estimates of how many differ between sources, from around 1 in 5 to around 3 in 10, so we will not pick a single figure.

What the NHS sources do say is that nail changes are more common in people who have psoriatic arthritis. Nidirect says most people who develop psoriatic arthritis also have changes in their nails. NHS Inform says nail changes are less common when only the skin is affected, and NHS.UK lists nail changes among the symptoms of psoriatic arthritis.

That is not the same as saying that nail psoriasis means you have or will get psoriatic arthritis. Nail changes are common in psoriasis, and only some people with psoriasis develop psoriatic arthritis. What it does mean is that your nails are worth mentioning to your GP or specialist, along with any joint symptoms. NICE guidance for England recommends that people with any type of psoriasis be offered a check for psoriatic arthritis every year.

Joint pain, stiffness or swelling that keeps coming back should always be checked, even if your nails look fine. Our page on Symptoms of Psoriatic Arthritis describes what to look out for.

What causes it?

Psoriasis is thought to be linked to the immune system, and it can run in families. NHS.UK says it is not known exactly why or how it happens. We could not find an approved source explaining why psoriasis affects the nails of some people and not others, so we will not guess.

NHS.UK lists injury to the skin, such as cuts and scratches, among the things that can make psoriasis worse. Stress is another trigger it names. Triggers vary from person to person. If you have noticed a pattern, it can be worth mentioning to your GP.

How long do nails take to grow out?

Nails grow slowly, so changes in a nail do not clear quickly, even when the cause is being treated.

We could not find an approved source that gives a growth time for nails affected by psoriasis. As a rough guide to how slowly nails grow, NHS.UK says that a fingernail lost after an injury should grow back within about 6 months, and a toenail can take up to 18 months. Those figures are about injury, not psoriasis. They show that it can be a long wait, and that toenails take longer than fingernails.

If you are looking after your nails and not seeing a change for a while, that is common. Ask your GP or specialist what to expect for your own nails.

How is it diagnosed?

Your GP can often tell whether a nail change might be psoriasis by looking at your nails and skin and asking about your health, including any joint symptoms. If there is doubt, a GP may take a sample to rule out a fungal infection or refer you to a dermatologist (a skin specialist).

NICE guidance for England says a GP should refer someone to a dermatologist if there is doubt about the diagnosis, or if nail disease is having a major effect on how the nails work or look. Specialists can use a nail scoring tool to measure the severity of changes and assess how a treatment is working.

It can be useful to bring photos of your nails to an appointment, especially if they change from week to week.

What care might the NHS offer?

We cannot say what is right for you. A GP, dermatologist or pharmacist can do that. In general terms, the NHS describes these kinds of support. You can read more in Treatment for Psoriatic Disease.

• Treatments applied to the nail or skin. Creams and similar treatments are usually the first step in psoriasis care. NICE guidance for England states that, for nail disease, these on their own are often not enough and that other options can be offered alongside them.

• Specialist care. If nail psoriasis is painful or affecting daily life, a GP may refer you to a dermatologist. Stronger medicines that work throughout the body are prescribed by specialists and require regular monitoring. NHS.UK and NHS Inform note that some of these can help both skin and joints. Whether they are right for you is a conversation to have with your specialist.

• Podiatry. NHS.UK says that if your nails are too tough to cut or you cannot reach them, you can see a podiatrist, and in some areas of England, you can self-refer without seeing a GP.

NHS.UK also gives everyday nail care tips for nail problems in general: wear rubber gloves if your hands are often in water or in contact with cleaning products, use hand cream on your nails and fingertips, trim your nails regularly, and do not bite or pick at your nails or the skin around them. This is general advice for nails, not treatment for psoriasis.

Some people find that keeping nails short and avoiding knocks makes daily life easier. This is lived experience rather than medical advice, and everyone is different.

How guidance differs across the UK

• England: NICE guideline CG153 covers the assessment and management of psoriasis, including nail disease. NHS.UK explains psoriasis, nail problems and fungal nail infection. Some areas allow self-referral to a podiatrist for nail problems, though this varies by location.

• Scotland: Scottish guidance comes from SIGN rather than NICE. We have not confirmed what it says about nail psoriasis. NHS Inform, run by NHS 24, has a section on nail psoriasis within its psoriasis page. Whether podiatry self-referral for nail problems is available in your area is unconfirmed.

• Wales: NHS 111 Wales has health information on psoriasis and on fungal nail infection. NICE says that in Wales, Welsh commissioning positions apply. Whether CG153 is followed in every Welsh health board is unconfirmed, as is podiatry self-referral.

• Northern Ireland: nidirect has a psoriasis page that mentions nail involvement, as well as pages on psoriatic arthritis and fungal nail infection. NICE says that in Northern Ireland, Northern Irish commissioning positions apply. Whether CG153 is followed in every Health and Social Care Trust is unconfirmed, as is podiatry self-referral.

What is the same in all four nations is that your GP is the first place to go, you can be referred to a dermatologist, nail psoriasis is not contagious, and in an emergency, you call 999. Links to each nation's health information are in the Helpful links below.

When to speak to your GP or specialist

Contact your GP if:

• Your nails have changed shape, colour or texture, and you do not know why

• You think you may have nail psoriasis, with or without skin patches

• Your nails are painful, or are making everyday tasks difficult

• You have psoriasis, and your treatment is not working or is causing side effects

• You have joint pain, stiffness or swelling that keeps coming back

• The way your nails look is affecting your mood, confidence, work or sleep

If you are not sure, call your GP surgery and describe what you are noticing. You can also ask a pharmacist for advice.

When to get urgent help

Call 999 or go to A&E if you have psoriasis and:

• Your skin quickly turns red, and you develop white, pus-filled bumps that join together (redness can be harder to see on darker skin)

• Patches on your feet turn yellow-brown and fill with pus

• Your fingers or toes have red, scaly, pus-filled bumps on the tips

You may also have a fast heartbeat, a high temperature, or feel hot, cold or shivery. These can be signs of a more serious condition or an infection. This guidance is taken from NHS.UK.

Get medical advice promptly, through your GP or your local urgent care service, if the skin around a nail becomes sore, red, swollen and warm, which NHS.UK says can be a sign of infection, or if you have a painful red eye or changes in your sight.

Looking after your wellbeing

Nail changes are visible, and they can affect how you feel about your hands and feet and what you feel comfortable doing. It is common to feel self-conscious, anxious or low about them. This is not a weakness, and it is worth telling your GP. Our page on Living Well with Psoriatic Disease has more ideas.

If you are struggling, you can talk to your GP about mental health support. The Samaritans offer a listening ear at any time on 116 123. Many people also find it helps to talk to others who understand.

Support from our community

You are welcome in our peer support spaces, where people share their experiences of psoriasis and psoriatic arthritis. Find out how to join on our Get Support page:

• the PSOcial Space on Discord

• our Facebook peer support group, where anonymous posting is available

Key points

• Nail psoriasis is psoriasis affecting the fingernails or toenails. Around half of people with psoriasis have nail changes.

• It can cause pits, ridges, colour changes, thickening, crumbling or a nail lifting away. It can be painful and affect daily tasks.

• It is not contagious. A fungal nail infection can look similar and can spread, and a GP can help tell them apart.

• Some people have nail changes before or without skin patches.

• Nail changes are more common in people with psoriatic arthritis, but nail changes alone do not mean you have it. Tell your GP about any joint symptoms.

• Nails grow slowly, so changes can take a long time to grow out.

• Your GP is the first step. Care across the UK is broadly similar, though guidance and services differ by nation.

Helpful links

More from Psoriatic Disease UK

• What is Psoriatic Disease: an introduction to psoriasis and psoriatic arthritis

• Symptoms of Psoriasis: common signs and rarer types of psoriasis

• Getting a Diagnosis of Psoriatic Disease: what to expect from your GP and specialist

• Treatment for Psoriatic Disease: the kinds of treatment the NHS may offer

• Symptoms of Psoriatic Arthritis: joint symptoms to watch for

• Living Well with Psoriatic Disease: everyday life, energy and wellbeing

• Guttate Psoriasis: another type of psoriasis, with lots of small spots

• Get Support: our PSOcial Space on Discord and Facebook peer support group

Trusted health information by nation

• NHS.UK: Psoriasis (England): symptoms, treatment and when to get urgent help

• NHS.UK: Nail problems (England): common causes of nail changes, nail care and when to see a GP

• NHS.UK: Fungal nail infection (England): symptoms, treatment and prevention

• NHS Inform: Psoriasis (Scotland): includes a section on nail psoriasis

• NHS Inform: Fungal nail infection (Scotland): symptoms and treatment

• NHS 111 Wales: Psoriasis (Wales): symptoms, treatment and when to get urgent help

• NHS 111 Wales: Fungal nail infection (Wales): symptoms, treatment and prevention

• nidirect: Psoriasis (Northern Ireland): includes a note on nail involvement

• nidirect: Fungal nail infection (Northern Ireland): symptoms, causes and treatment

• NICE guideline CG153: Psoriasis: the clinical guideline for England on assessing and managing psoriasis

Emotional support

• Samaritans: a listening ear at any time, on 116 123

Last reviewed: 2 November 2026. Next review due: 2 November 2027.

This page is for general information only and is not medical advice. Psoriatic Disease UK is a patient-led organisation, and we are not medically trained. Always speak to a qualified healthcare professional about your own health.