Nail Psoriasis
Up to half of people with psoriasis have nail changes, and most people with psoriatic arthritis do. Nails are slow and stubborn to treat because they grow slowly, but they do improve, especially with modern injections.
What it looks like
- Pits: small dents in the nail surface, like a thimble
- Oil-drop or salmon patches: yellow-orange marks under the nail
- Lifting (onycholysis): the nail separates from the bed, often from the tip
- Thickening and crumbling, with scale building up under the nail
- Fingernails are more often affected than toenails
Nail psoriasis is a clue for psoriatic arthritis. Tell your GP about any joint swelling, heel pain or morning stiffness.
Psoriasis or fungus?
- They look similar, and you can have both
- A nail clipping sent to the lab confirms fungus before months of antifungal tablets
- Psoriasis elsewhere and pitting point towards psoriasis
- Fungus more often starts in one toenail and spreads
Twelve weeks of antifungal tablets for a nail that never had fungus is a lot of liver tests for nothing.
What helps
Expect slow progress: fingernails take about 6 months to grow out, toenails 12–18 months.
- Step 1 · EveryoneNail care: keep nails short, wear gloves for wet or rough workInjury makes nail psoriasis worse. Skip aggressive manicures and cleaning under the nail.
- Works
- Reduces flares and lifting
- Cost
- Free
- How long
- Ongoing
- Watch for
Your cuticle is a seal, not a decoration. Leave it be.
- Step 2 · GPStrong steroid, with or without calcipotriol, to the nail fold and under lifted nailApplied nightly to the skin around the nail.
- Works
- Modest improvement over months
- Cost
- PBS or $20–60
- How long
- 3–6 months
- Watch for
- Thin skin around the nail with long use.
- Step 3 · DermatologistSteroid injections into the nail foldTriamcinolone injected beside the nail.
- Works
- Helps pitting and thickening in many people
- Cost
- Specialist fees
- How long
- Every 4–8 weeks for a few rounds
- Watch for
- Stings; local anaesthetic helps.
- Step 4 · Dermatologist or rheumatologistBiologic injections or tabletsIL-17, IL-23 and TNF biologics clear nails better than anything else, especially if there’s skin or joint disease too.
- Works
- Many people get clear or near-clear nails within a year
- Cost
- PBS if criteria are met (usually for skin or joint disease)
- How long
- 6–12 months to see full effect
- Watch for
- Infection screening first.
Costs are rough Australian prices and vary by pharmacy and provider. PBS co-payment: $25, or $7.70 with a concession card. Results are typical figures from trials, not promises.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Antifungal tablets without a positive testWon’t help psoriasis and carry side effects.
- Tea tree oil and nail “hardeners”No evidence for psoriasis; can irritate.
- Biotin for nailsNo benefit in psoriasis and can upset some blood tests, including thyroid and heart tests.
Common questions
What does nail psoriasis look like?
Small pits, yellow-orange oil-drop patches, nails lifting from the bed, thickening and crumbling.
How do I know if it’s nail psoriasis or fungus?
They can look the same. A nail clipping test confirms fungus. Psoriasis elsewhere or pitting points to psoriasis.
How long does nail psoriasis take to improve?
Months: fingernails take about 6 months to grow out and toenails 12 to 18 months, so treatments need time.
Helpful resources
- Psoriasis AustraliaPatient support and information. Free.
- Arthritis AustraliaInformation on psoriatic arthritis and living with it. Free.
- Australasian College of Dermatologists: A–Z of skinDermatologist-written patient information. Free.
Evidence and more information
- Zhang S et al. Biologics targeting IL-17/IL-23 in scalp, nail and palmoplantar psoriasis: network meta-analysis (Front Immunol 2026)
- Madani A et al. Intralesional triamcinolone for nail psoriasis: systematic review (Dermatol Online J 2026)
- Gossec L et al. EULAR recommendations for psoriatic arthritis: 2023 update (Ann Rheum Dis 2024)
maladywise.com/nail-psoriasis/