Nail psoriasis can be painful, but treatment options like topicals, injections, and lasers may help ease your symptoms.

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Psoriasis is an autoimmune disease that causes your body to overproduce skin cells. It most commonly causes thick, raised skin plaques to develop on your body.

When psoriasis affects your nails, it’s known as nail psoriasis. Up to 9 in 10 people with psoriasis may experience nail psoriasis at some point during their life.

Nail psoriasis may cause symptoms like pitting, discoloration, and crumbling of the fingernails and toenails, which could make completing daily tasks more difficult.

According to a 2021 review, nail psoriasis can be challenging to treat, but treatment is possible. The best approach for you may depend on your specific symptoms and their severity.

Keep reading to learn more about the four main treatment approaches for nail psoriasis.

Topical treatments are creams or ointments you apply directly to the affected area. Specific nail psoriasis symptoms will typically determine where you use the medication.

If you have symptoms that affect the nail itself, such as pitting, you’ll apply the topical medication to the area where the skin meets the hard part of the nail (proximal fold). This allows medication to soak into the nail matrix, which is at the base of the nail and where your fingernails begin to grow.

If your symptoms affect your nail bed, you may want to apply the medication to the skin under your nail. Trimming your nails beforehand may help you get the medication in the right spot.

A dermatologist — a doctor who specializes in treating skin, hair, and nail conditions — will most likely recommend topical treatments for nail psoriasis if you have mild symptoms that only affect one or two nails.

They may prescribe one of the following options:

Patience is key when using topical treatments. Since nails grow slowly, you’ll need to apply topical treatments once or twice daily for several months, according to the American Academy of Dermatology.

Insurance for nail psoriasis treatments

Most treatment options for nail psoriasis require a prescription from a healthcare professional.

Many insurance providers, including Medicare and Medicaid plans, will cover topical treatments for nail psoriasis. However, the number of treatment sessions covered may vary.

If you have insurance, check your coverage before making your appointment. If you don’t have insurance, consider speaking with a healthcare professional in your area to see if they offer payment plans, discounts, or other financial assistance.

If topical treatments don’t help your symptoms, a dermatologist may recommend corticosteroid injections. With an injection, a healthcare professional administers the medication directly into the affected area underneath your nail.

Before you receive an injection, the healthcare professional administering the injection may apply a local anesthetic to numb the area.

You can get these injections into each quadrant of the nail bed via the side of your finger or toe and into your nail matrix. You may receive up to five shots per finger or toe, depending on how widely your nail psoriasis has spread.

Corticosteroid injections are generally safe, but they may cause temporary side effects, such as:

  • a pins-and-needles feeling after the anesthetic wears off
  • blood under your nails
  • discoloration to the proximal fold that appears brown, red, or purple, depending on your skin tone
  • proximal fold atrophy, which is when your skin retreats back from your nail

You can repeat this treatment once every 4 to 8 weeks until your symptoms improve.

A pulsed dye laser can burn away diseased cells with minimal harm to the surrounding healthy tissue.

During treatment, a doctor or dermatologist places a handheld device against your finger or toe. They’ll fire off a laser pulse, which may feel like someone snapped a rubber band against your nails.

This procedure is usually less painful than injections. You can relieve any lingering soreness with a cold compress. You may also notice some bruising or dots of blood where the laser hit.

You’ll likely need three sessions, one per month, before your symptoms disappear for good.

Do other light therapy treatments work?

Other psoriasis light therapies may also help nail psoriasis, but they’re more effective for skin symptoms.

As of 2019, pulsed dye laser therapy is the only light therapy treatment that’s recommended for nail psoriasis by the American Academy of Dermatology and the National Psoriasis Foundation.

Experts usually recommend this approach for moderate to severe nail psoriasis that involves:

  • nail crumbling or splitting
  • separation from the nail bed
  • symptoms that don’t respond to usual treatments

Pulsed dye laser therapy is typically effective for persistent symptoms, but it’s expensive. An insurance plan may not cover it unless you can prove topical treatments and injections haven’t worked for you.

Systemic therapies refer to pills, tablets, or infusions that carry medication to your whole body. They may help with nail symptoms, but they might not be as effective as more targeted therapies like topicals or injections.

A healthcare professional may prescribe systemic therapies in some cases, including if:

  • you have extensive skin lesions as well as nail symptoms
  • you have psoriatic arthritis
  • your symptoms affect four or more nails
  • your symptoms affect your quality of life

Systemic therapies used to help treat nail psoriasis may include:

Nail psoriasis isn’t a life threatening condition, but it can affect your quality of life. So it’s important to speak with a healthcare professional as soon as you notice symptoms.

Untreated nail psoriasis usually worsens over time, causing more damage to your nails. Severe symptoms may:

  • expose tissue to bacterial or fungal infections
  • interfere with daily activities, such as typing or walking
  • make some of your nails disappear entirely

Nail psoriasis may also be a key risk factor for psoriatic arthritis if not treated.

What vitamin is good for nail psoriasis?

According to a 2023 review, a topical cream that combines vitamin D and a derivative of vitamin A called tazarotene may benefit nail psoriasis.

Is Vaseline good for nail psoriasis?

Very few studies have examined the effects of petroleum jelly on nail psoriasis. However, some research suggests that petroleum jelly may help improve psoriasis symptoms by improving skin barrier function.

Nail psoriasis symptoms may cause pain and interfere with daily life, but treatment can help.

Topical treatments often work well for mild symptoms. If you have moderate to severe symptoms, a healthcare professional may recommend injections, pulsed dye laser therapy, or systemic therapies.

Early treatment can help you manage symptoms and prevent them from getting worse.

Emily Swaim is a freelance health writer and editor who specializes in psychology. She has a BA in English from Kenyon College and an MFA in writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find her on Twitter and LinkedIn.