The Difference Between Toenail Psoriasis and Toenail Fungus

You may not have given much thought to your toenails during winter and spring. But summertime brings out the sandals and bare feet. Suddenly, your toenails are at the forefront of your consciousness: Why do they look so bad?

Instead of healthy nails with distinct crescent moons and a smooth surface, they look ridged, pitted, or crumbly. Whether or not they’re painful, your toenails are an embarrassment.

Are crumbly, pitted, or discolored toenails a sign of infection? They could be. They could also result from an autoimmune disease called psoriasis. How can you tell?

Babak Kosari, DPM, FACFAS, is an expert podiatrist in Northridge and Santa Clarita, California. He diagnoses and treats toenail psoriasis and toenail fungus. Although the diseases look similar, they require different treatments.

Do you have toenail psoriasis or a toenail fungus? Here we explain the difference, but you need to see a podiatrist for diagnosis and appropriate treatment.

Do you have skin psoriasis? 

If you have the autoimmune disease psoriasis and notice changes to your toenails, your best guess should be toenail psoriasis. 

With psoriasis, skin symptoms usually precede nail symptoms. If you’ve battled plaques on your skin, look for something similar on your toenails. About half of those with psoriasis have toenail psoriasis. It’s also possible to develop nail symptoms first. 

Symptoms that suggest your nail changes are due to this autoimmune disease include:

• Tiny dents or pits in your nails
• Crumbling toenails
• Yellow, brown, or white toenails
• Nail separates from nail bed
• Chalky debris under nail
• Blood under nail

Contact your podiatrist if you notice nail changes, whether or not you have psoriasis. Your podiatrist can clear your symptoms to reduce pain and normalize the look of your nails. 

If we diagnose toenail psoriasis, we work with your dermatologist to help keep your toenails clear. Toenail psoriasis is often a precursor to a more significant complication of psoriasis called psoriatic arthritis.

It takes about six months to clear debris from under the nail and restore it to health as it regrows after treatment. 

Are your nails dark and smelly?

While both a fungal infection — known as onychomycosis — and toenail psoriasis create crumbly and discolored nails, onychomycosis has a few other symptoms not shared by psoriasis. Signs you could have onychomycosis include:

• Crumbly nails
• Misshapen nails
• Dark nails
• Brittle or dull nails
• Foul odor from nails

You might also notice changes to the skin on your feet. If a fungal infection spreads from your toenails to the toe and foot skin, you have athlete’s foot in addition to your nail infection.

You might have both

Even if you have psoriasis and nail psoriasis, that doesn’t mean your crumbly nails aren’t partially due to a fungal infection. Nail psoriasis makes your toenails more susceptible to infections, so it’s possible to have both at the same time.

Treatments differ for each

If you have a toenail fungus, your podiatrist may treat you with an antifungal agent. Depending on the severity, they may prescribe a topical treatment, oral medication, or both. They may also need to remove the diseased portion of the nail. Toenails may take months to recover.

If you have toenail psoriasis, treatment can be similar to that used for skin psoriasis. You may require steroid injections to your nail bed and vitamin D topical ointments. Severe cases could require light therapy or biologics. Your podiatrist may remove the diseased part of the nail.

Are you bothered by crumbly, painful, or discolored toenails? Find out whether you have toenail psoriasis, a fungal infection, or both by phoning the office nearest you or scheduling an appointment online today for a toenail evaluation.