Nail Psoriasis vs. Fungus: Symptoms, Causes, Treatment

Nail psoriasis and nail fungus are two of the most common causes of nail changes. Both conditions cause changes in the texture and color of your nails. They may have similar symptoms, making it hard to tell the difference.

However, the causes of nail psoriasis and nail fungus differ. Psoriasis is a chronic inflammatory autoimmune disease that can affect your nails, skin, hair, and joints. Nail fungus is a broad term that can be used to describe any type of fungal growth or infection of the nails. Your treatment will vary depending on which you have, so it's important to get the right diagnosis.

This article covers the differences between nail psoriasis and nail fungus, including the symptoms and causes. It also discusses how each condition is diagnosed and treated.

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Nail fungus and nail psoriasis look very similar. They both can result in changes in nail texture and color, as well as structural problems of the nail bed. Your healthcare provider or dermatologist can detect the subtle differences that set these two conditions apart.

It's also possible to have both of these conditions at the same time. In fact, some types of nail fungus are particularly common in people with nail psoriasis and appear in about 10% of people with that condition. The weakening or splitting of the nails with psoriasis makes it easier for organisms to enter and colonize the nail bed.

Nail psoriasis and nail fungus share some symptoms. The most common shared symptoms and what they look like are described below:

There are also some hallmark symptoms that are specific to each condition.

For nail psoriasis, this includes:

For nail fungus, symptoms to expect include:

While symptoms and clinical signs of both of these nail conditions share several similarities, their causes are very different. Here's what to know about the causes of nail psoriasis and fungus.

The exact cause of nail psoriasis, or psoriasis at all for that matter, isn't clear. This chronic, autoimmune condition is believed to develop from one or more of the following factors:

Many people who have plaque psoriasis or psoriatic arthritis will have nail psoriasis at some point during the course of their disease. For some people, it can even appear as a standalone symptom, without any signs of psoriasis on other parts of the body.

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Nail fungus is not a chronic condition, but severe fungal infections can be difficult to clear completely. Fungal infections of the nail are caused by microscopic organisms that can include molds or yeasts.

Some of the most common fungi identified in nail infections include:

In addition to underlying causes of nail psoriasis and nail fungus, there are certain risk factors that may make an infection or flare-up more likely. Here are the risk factors for nail psoriasis vs. fungus:

Nail psoriasis:

Psoriasis can be inherited, so you may be at risk if this condition runs in your family. Other possible risk factors for psoriasis, as well as triggers for flare-ups, include:

Nail fungus:

Anyone can develop a fungal nail infection, but nail fungus is most common in people with weakened immune systems or who have:

Your dermatologist or other healthcare provider may make a diagnosis on a visual inspection of your skin alone, but there are additional tests that might be used to confirm the cause of your nail problem.

Testing of your nail through a biopsy (removing a sample to be analyzed in a lab) or by analyzing nail clippings can help confirm a psoriasis diagnosis. Your healthcare provider will also examine other areas of your body for additional plaques or lesions. In some cases, dermoscopy, a close-up examination with a lighted tool called a dermatoscope, may also be used.

In order to confirm nail fungus or the specific organism causing a fungal infection, your provider may take a scraping or nail sample for testing. Lab tests of the skin or nail particles can be used to pinpoint the exact fungi causing the problem and help guide treatment.

Because nail psoriasis is a chronic condition and nail fungus is an infection, treatment strategies are very different for these two conditions.

To get rid of nail psoriasis, your treatment will depend on the severity and extent of the condition.

For mild or limited cases of nail psoriasis, topical treatments are usually used, including:

In more severe or widespread cases, treatment may include injected or oral medications and other treatments like:

Both skin and nail fungal infections are usually treated with the same medications. An antifungal medicine is used to kill the fungi causing the problem, or in some cases slow the growth. The antifungal used to treat your nail fungus may be used for a variety of organism types, or it may be tailored to a specific organism if the exact cause of the growth is identified.

Since nail fungus can be difficult to treat, your doctor may even prescribe an oral antifungal medication. Even with treatment, these fungal infections can take several months or more to resolve completely.

Managing psoriasis requires ongoing treatment, so working with a dermatologist to control your condition is helpful.

When it comes to nail fungus, you may try to treat it on your own, but prescription-strength formulas and treatments can help keep fungi from growing out of control.

With either condition, it helps to seek treatment early, before pain and tenderness or nail damage occurs.

The prevention strategies for nail psoriasis vs. nail fungus are different because their causes are different.

Since nail psoriasis can be inherited, there may not be anything you can do to prevent it. However, avoiding certain chemicals or environmental pollutants may help. It's also helpful to have good control over your psoriasis in general. Systemic medications like biologics or methotrexate can help you keep psoriasis in check throughout your body, including on your nails.

When it comes to fungal infections, keeping the affected area dry and clean is an essential prevention strategy. The Centers for Disease Control and Prevention (CDC) suggests taking the following measures to prevent nail fungus:

Both nail psoriasis and nail fungus can make your nails thicken, detach from the nail bed, or change color. Psoriasis can develop from a number of causes, but yeasts and molds lead to fungal nail infections. Keeping your nails clean and short, and managing your overall health can help prevent both of these conditions.

If you have psoriasis, there's a chance you will develop symptoms of the condition on your nails at some point in your life. It can also make you more prone to fungal infections of the nail. Nail fungus also can develop on its own, especially in people with weak immune systems or whose hands and feet are often wet or uncared for.

If you have discoloration, cracking, or tenderness on your finger or toenails, your healthcare provider can help you identify the exact cause in order to identify the most effective treatment.

Psoriasis is not contagious, but some types of fungal infections can be shared with others. It's important to not share nail clippers or other hygiene products. You should also avoid walking barefoot in locker rooms and other wet, public places.

Psoriasis cannot be cured, but there are a number of treatments that can help control the condition to reduce symptoms.

There are topical (applied directly to the nail) and systemic (work throughout the body) treatments that can help reduce your symptoms of nail psoriasis, but you may not be able to get rid of the condition completely.

Nail fungus often develops when you've picked up a type of fungi in a contaminated area, or molds and yeasts colonize on moist areas. Keeping your hands and feet clean and dry and your nails short can help prevent nail fungus.

It's generally not a good idea to get gel manicures over damaged nails. While gel nails can cover the appearance of nail fungus or nail psoriasis, gel manicures can be damaging to your nails on their own. Placing gels over a damaged nail can increase the problems you are already experiencing on your nails.

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By Rachael Zimlich, BSN, RNRachael is a freelance healthcare writer and critical care nurse based near Cleveland, Ohio.