Why are My Nails Turning Into Crumb Cake?

Curated by Claudia Shannon / Research Scientist / ishonest

First up, what exactly is psoriasis?

Psoriasis is due to immune system dysregulation affecting the skin. Cells overproduce at a rapid rate, resulting in red, scaly lesions on the skin. Psoriasis isn’t contagious, but is often hereditary. However, the same can’t be said for nail fungus.

Enter nail fungus

Nail fungus (aka Onychomycosis) is a contagious infection that begins as white or yellow discoloration on the tip of your nail. It’s caused by fungi organisms — luckily not the mushrooms on your pizza.

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As the fungal infection penetrates the skin under the nail bed, the nails begin to thicken and crumble.

Psoriasis psucks

According to the International Federation of Psoriasis Associations (IFPA), nearly 125 million people have psoriasis worldwide. That’s about 1.5 percent of the world’s population. It affects women and men at the same rate. Around half of those with psoriasis have nail psoriasis.

Nail psoriasis is more common on the toenails than the fingernails.

Symptoms may appear after an injury to the toes or fingers. Something as innocent as a stubbed toe may trigger a reaction.

The fungus among us

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Nail fungus is both contagious and common. You can pick it up through physical contact with an infected person or object.

Fungal organisms have a field day in warm, moist environments. If fungi were conscious, they would daydream about warm, sweaty feet encased in running shoes.

Those with a weakened immune system (like with HIV/AIDs or diabetes) are more likely to contract a fungal infection. Elderly people are also more susceptible to nail fungus. Sorry, Grandma.

Or, maybe Athlete’s foot has taken your little piggies hostage

Athlete’s foot (tinea pedis) occurs when a fungal infection affects the skin on your feet.

Signs of athlete’s foot include:

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Toenail fungus infections can often arise from athlete’s foot.

Can you have psoriasis and toenail fungus?

Yes. Many people with nail psoriasis will also experience fungal infections. Unfortunately, there isn’t one medication to fight both at the same time since they’re completely different diseases.

Treatment options

Nail psoriasis can be difficult to treat. Topicals typically used in psoriasis, such as topical steroids, calcipotriene (a vitamin D cream), tazarotene (a vitamin A cream), and tacrolimus (a topical immunosuppressant) are not likely to help very much in nail psoriasis.

Other prescribed treatments that may be more successful include:

  • methotrexate, cyclosporine, and apremilast
  • corticosteroid injections to the nail bed
  • biologics

Treating nail fungus

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There are countless antifungal topical creams, ointments, and oils on the market to combat nail fungus. For a more aggressive treatment, your doctor may prescribe antifungal pills in order to be more successful. Topical medications have a hard time penetrating to the source of the nail fungus.

These medications include:

  • fluconazole (Diflucan) — off-label
  • griseofulvin (Gris-Peg)
  • itraconazole (Sporanox)
  • terbinafine (Lamisil)

When to see a doctor

If you suspect psoriasis or have a family history of psoriasis, reach out to your healthcare provider. If you have a new, worsening dark discoloration on one nail in particular, though rarer, this can be a sign of melanoma of the nail.

If you suspect mild fungus, you may manage the symptoms with over-the-counter creams. If creams don’t improve symptoms in a few weeks, visit your healthcare provider. Nail fungus usually requires an oral prescription antifungal for successful treatment.

Preventing fungus

Good hygiene can’t prevent psoriasis, but it can help ward off fungal infections.

Fight the fungus with these tips:

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