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| Nail psoriasis symptoms | Nail fungus symptoms | |
|---|---|---|
| Color | Ivory spots or yellow patches, oil discoloration, or red or brown streaks | Widespread yellowing or browning, sometimes with brown or black spots |
| Pitting | Yes | No |
| Shape | Uneven thickening, grooves, or misshapen nails | Uniform thickening, with curved or raised nails |
| Nail bed separation | Yes, with salmon spots near the separation | Yes, with rough, jagged edges |
| Buildup under the nails | Hyperkeratosis (thick skin buildup under nails) | Powdery debris under nails |
| Skin changes | Scaly patches of skin near the nails | No scaling of the skin |
| Odor | No odor | Foul odor is common |
A major difference between nail psoriasis and nail fungus is their causes. The diagnostic process and treatments for these conditions are also quite different.
Causes and Risk Factors Are Different
Nail psoriasis happens when your immune system mistakenly attacks the skin under the nail, causing inflammation. It often occurs alongside skin psoriasis or psoriatic arthritis, which causes joint pain, stiffness, and swelling. Risk factors include:
- Having a family member with psoriasis
- A weakened immune system
- A nail injury
- Psoriatic arthritis (80-90% of people with psoriatic arthritis also have nail psoriasis)
Nail fungus occurs due to an infection with fungus, yeast, or molds. Risk factors include:
- Aging
- Athlete’s foot
- Diabetes
- Frequent exposure to moisture
- Genetics
- Living with someone who has nail fungus
- Hygiene issues
- Psoriasis
- A weakened immune system
They May Affect Different Nails
Nail psoriasis can affect both your fingernails and toenails, while nail fungus is 7-10 times more likely to affect your toenails than your fingernails. Fungi thrive in warm, damp environments, which are more common around your feet than your hands.
Healthcare Providers Use Different Methods for Diagnosis
To check for nail psoriasis, healthcare providers examine your nails and ask about any symptoms. They may also take a biopsy (a small piece of your nail) to examine under a microscope, or look for signs of psoriasis on your skin, especially on your elbows, knees, or scalp.
To find out if you have nail fungus, a healthcare provider may collect small pieces of your nail or debris from under it. In addition to examining these samples under a microscope, they may order diagnostic lab tests, such as a culture, to see the fungus more clearly and determine its type.
They Have Different Treatment, Progression, and Outcomes
Healthcare providers treat nail psoriasis by reducing inflammation and regulating the immune system using corticosteroids, biologics, light therapy, or immunosuppressants.
Treatment for nail fungus may involve antifungal medications, laser therapy, or nail removal.
Nail psoriasis is usually a chronic (long-term) condition with symptoms that come and go. It can lead to nail or cuticle loss, which is less common in nail fungus. With nail psoriasis treatment, it takes about six months for fingernails to grow back, and up to a year for toenails.
Nail psoriasis and nail fungus share some similarities in prevention, demographics, and their chronic nature.
They Affect Similar Demographics
Both nail psoriasis and nail fungus can affect anyone, but your risk increases if you have a family history, a compromised immune system, or underlying autoimmune disorders.
You Can Use Similar Prevention Strategies
Strategies for lowering your risk of nail psoriasis or nail fungus are similar. They include:
- Avoid nail injury
- Keep your hands dry; use gloves when cleaning, handling chemicals, or washing dishes
- Keep your nails neat, trimmed, and clean
- Wear footwear that fits well
- Wear sandals or slippers to protect your feet in public places like gyms, pools, saunas, and hotels
Both May Need Long-Term Management
Both conditions can be long-term issues that need regular care. Nail fungus improves more easily with treatment, but both can return if they are not managed properly.
You can have nail psoriasis and nail fungus at the same time, with mixed infections making up about 5% of all cases.
Having nail psoriasis or taking immunosuppressant medications for psoriasis can increase your risk of fungal infections. If you have both conditions, your healthcare provider may treat the fungal infection first to see if it improves your symptoms.
It’s important to see a healthcare provider if you notice changes in your nails that don’t improve with home care or if your symptoms worsen. Watch for signs that may need medical attention, including:
- Nail separation
- Brittle nails
- Persistent discoloration
- Severe pain
- Signs of infection, such as swelling, redness, or pus
A primary care provider may refer you to a specialist in dermatology, podiatry, or rheumatology. Dermatology providers focus on skin and nail conditions, while podiatry providers specialize in foot and toenail health. Rheumatology providers treat autoimmune conditions, such as psoriatic arthritis.
Nail discoloration, thickening, and separation can occur due to nail psoriasis, an autoimmune condition, or nail fungus from fungi, yeast, or mold.
Both conditions may require ongoing management. A dermatologist or podiatrist can help you find the correct diagnosis and get proper treatment.
