How to tell the difference between nail psoriasis and nail fungus

If you’re noticing some unusual changes to your nails, like discoloration or thickening, this could be a sign of either nail psoriasis or nail fungus. These conditions can look similar, but they also have some key differences.

For example, each condition can cause slightly different symptoms. They also have different underlying causes and, therefore, different treatment methods.

It’s always best to get it checked out by a doctor, whether in person or online. They will be able to diagnose you effectively and develop a treatment plan that works for you.

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What is nail psoriasis?

Psoriasis is a common condition affecting around 2% of the population in the United States. It’s an autoimmune condition, meaning it results from your immune system mistakenly attacking healthy cells. Research shows it’s largely genetic, with genetic factors explaining about 70% of your susceptibility to developing it.

The most notable symptom of psoriasis is the development of plaques, which are scaly, discolored patches of skin that can cause pain and itching. Some 2017 research suggests that as many as 90% of people with psoriasis will experience it on their nails. This may be either their fingernails or toenails, but it’s most commonly the fingernails.

The key symptoms specific to nail psoriasis include:

• crumbling nails
• nails separating from the nail bed
• dents appearing in your nails
• discoloration, usually white, yellow, or brown
• a thick buildup beneath your nail

What is nail fungus?

Unlike psoriasis, onchyomycosis (nail fungus) happens due to an external source. It results from an infection by a type of fungus. The most common is dermatophytes, found in 90% of toenail fungus infections and 50% of fingernail infections, but it can also be due to yeast or mold.

Nail fungal infections can affect both your fingernails and toenails, but they’re more common in the toenails.

You can develop a fungal nail infection after being in a warm, wet place, like a public pool shower or locker room. They’re easily transmissible, so you can develop an infection if someone with a fungal infection walked barefoot in an area before you.

It’s also similar to athlete’s foot, a fungal infection of the toes and other areas of the feet. Wearing sweaty shoes and socks for a prolonged time can worsen it.

The common symptoms of nail fungal infections are:

• discoloration (commonly yellow or brown) at the tip of your nail that eventually spreads to the rest
• a foul-smelling nail
• crumbly, thin, or powdery nails
• a thick buildup under the nail
• splitting nails

According to the American Academy of Dermatology, it usually doesn’t cause pain except in severe cases, when wearing shoes can become painful.

How to tell the difference between nail psoriasis and fungus

While the symptoms are very similar, there are several questions you can ask yourself to help determine which you have:

• Where is it happening?: If it mostly affects the fingernails, it’s more likely to be psoriasis. If it’s mainly on the toenails, it’s more likely to be fungus.
• Does it smell?: Fungal infections can cause an odor, but psoriasis usually doesn’t.
• What other symptoms do I have?: If you experience other psoriasis symptoms like scaly skin plaques elsewhere on your body, it’s most likely nail psoriasis. If you’re experiencing symptoms of athlete’s foot (itchy, cracked skin on the feet), it’s most likely a fungal infection.

Treatments for nail psoriasis and fungus

Before treating your condition, speak with a healthcare professional to confirm which one is affecting you. The treatment method will differ depending on whether you have psoriasis or a fungal infection.

Nail psoriasis treatment

There are several treatments to manage nail psoriasis, but it’s important to remember that psoriasis is a chronic condition that’s unlikely to go away completely. Symptoms of nail psoriasis might clear up only to return at a later date.

If you have psoriasis, you can lessen the risk of developing nail symptoms by avoiding picking or biting your nails and being careful to avoid damage to your nails, for instance, when getting a manicure.

Topical medications are common treatments for nail psoriasis. These are often available as creams and ointments, but there are nail-specific options in the form of lacquers. Examples of these include formulations containing:

• clobetasol (Olux)
• betamethasone (Sernivo)
• tazarotene (Tazorac)

If topical medications don’t work, another option is injecting corticosteroids near the nail bed, most commonly triamcinolone acetonide (Kenalog-10).

Another common treatment for psoriasis is systemic medications that target your immune system directly rather than the affected area. Examples of these include:

• methotrexate (Trexall)
• cyclosporine (Neoral)
• apremilast (Otezla)
• secukinumab (Cosentyx)
• ixekizumab (Taltz)

Phototherapy is another option for nail psoriasis. This directs beams of light to the affected area. UV light is generally used in psoriasis, although this is less likely to be used for nail psoriasis. Instead, some research has shown a type of laser treatment has some benefits for nail psoriasis.

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Nail fungus treatment

Treatment for fungal infections can come in the form of a topical antifungal treatment you apply to the nail. This stops the fungus from spreading, but you must wait until the nail grows out for the original fungus to clear completely. In toenails, this can be 12 to 18 months. In fingernails, it’s around 4 to 6 months.

Topical antifungals for the nails include:

• ciclopirox nail lacquer (Ciclopirox)
• ketoconazole (Ketodan)
• clotrimazole (Canesten)

In severe cases, doctors might prescribe oral antifungals. These include:

• fluconazole (Diflucan)
• griseofulvin (Grifulvin V)
• terbinafine (Lamisil)
• itraconazole (Sporanox)

Online care for nail fungus and psoriasis

Both nail psoriasis and nail fungus are common conditions, but they can greatly affect your quality of life. A 2021 review states that nail psoriasis can cause pain and even psychological effects like embarrassment. Similarly, some 2023 research suggests that nail fungus causes physical and psychological effects.

Feelings of embarrassment could prevent someone from seeking treatment, with some research suggesting that shame may play an important role in healthcare access.

Online care services, including Optum Perks Online Care, may make getting treatment easier. With these services, you can submit an online form answering a few questions about your symptoms, and a licensed healthcare professional will respond soon after to prescribe a treatment plan – without the need to make an in-person appointment.

Summary

Nail psoriasis and nail fungus can look very similar. They both cause discoloration, crumbling, and thickening of the nail. However, they can also have some key differences.

The causes of both are different. Psoriasis is internal and likely genetic, while nail fungus is due to an external infection. They also most likely affect different nails. Psoriasis is more common in the fingernails, while nail fungus mostly affects toenails.

If you have a condition affecting your nails, you can start your treatment journey today by making an appointment with a healthcare professional or seeking care online.

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