Nail Psoriasis: Psoriasis is not just a skin disease

Many people think that psoriasis only affects the skin, but this is not the case!  Today we will cover nail psoriasis.  Psoriasis commonly occurs on the nails.  In fact, a psoriasis patient may have findings on the nail and no where else.

How does psoriasis affect the nail?  Psoriasis affects the part of the finger that makes the nail, and as a result, the nail can look different when it grows out.

Can psoriasis affect both the fingernails and toenails? Yes, it can affect both fingernails and toenails.

What does psoriasis on the nail look like?  Nail psoriasis can present with several findings including:

– Pits. These are little small dents on the nail surface

– Oil spots. These are yellowish spots that look oily

– Lifting of the nail. This is called onycholysis

– Rough and/or thickened nails

– Ridging of nails

– Brittle nails

– Debris under the nails

– White dots

While the above list can help with the diagnosis of nail psoriasis, many other conditions can affect the nails and look similar.  Additionally, nail psoriasis can also be a harbinger of joint involvement so don’t leave the diagnosis to yourself!

Axillary Granular Parakeratosis: A Rash of the Armpits

Certain rashes like to occur in the armpit.  For instance, you can get a yeast, bacterial (e.g. erythrasma caused by Corynebacteria), or fungal infection in the armpit, or an irritant or allergic reaction to a product (e.g. deodorant or antiperspirant).  Other types of skin diseases can also occur in the armpit area, e.g. psoriasis, hidradenitis suppurativa, etc.  A less common rash in the armpit is called axillary granular parakeratosis.

Axillary granular parakeratosis can present as reddish to brownish bumps or plaques.  While the term axillary refers to the armpit location, granular parakeratosis can occur elsewhere including the groin area and under the breasts.  It’s most common in middle-aged women, but can be seen in men as well.  Some people think that this is a reaction to deodorant or antiperspirant use as discontinuation of these products have helped in some cases.

Your doctor can help you diagnose the various types of armpit rashes.  Several in-office tests are available to determine what your rash could be.

Slammed your finger in the car door?

Closing the door on your finger can lead to a subungual hematoma (aka a collection of blood underneath your nail).
Closing the door on your finger can lead to a subungual hematoma (aka a collection of blood underneath your nail).

Last night I received a frantic text from a friend.  Turns out that the tip of her finger got caught in the car door leaving her fingernail with a crescent shaped purple mark under her index fingernail.  In addition to a bruiser and pain, she had some very valid questions for concern — especially since her wedding is just over 2 weeks away!!

How long will the purple mark/bruise last? First of all, bruises are made when our red blood cells leak out of our vessels.  As these red blood cells break down, they cause the red to purple to yellowish discoloration.  Bruises on the body usually disappear by 1-2 weeks time but the problem with a bruise underneath the nail is that some of the blood leaks out and gets caught under the nail.  The fancy medical term we use for this is subungual hematoma.  It’s a waiting game for the trapped blood to grow out with the nail.  Fingernails grow at about a couple millimeters a month.  So, be patient!

Will my nail lift off or fall off?  If the bruise is pretty small, as was the case with my friend, the nail will likely stay in place.  However, if a large area is involved, you may lose your nail. Think of it this way, the blood has created a barrier between your nail and the skin of your finger  underneath.

Depending on where and how much trauma occurs on the finger, it can lead to a broken bone in the finger (in which case, you’d need an xray to figure that out).   Also, if there’s a really large bruise or collection under the nail which causes a lot of pain, your doctor can drain it for you for your comfort.  So, if you have any concerns, you may need to go see urgent care, the emergency department or your primary physician.