Fungal or Psoriatic Nails?

They may look the same, but there are important differences between these two types of nail issues that you should know about.

Have your nails started to thicken recently?

Are they turning a discoloured shade of yellow or brown?

It’s easy to assume one thing: 

You have a fungal nail infection 

However, that’s not always the case.

What you may be experiencing is, in fact, a subtype of a chronic condition called nail psoriasis.

Although they can look like alike, there are a few signature signs to tell nail fungus and nail psoriasis apart, including this one major difference:

• Nail fungus rarely occurs on the hands and will typically be seen on the feet, since the feet receive less sunlight and overall exposure. Unlike a fungus, which usually affects just one or two nails, Psoriasis often strikes many nails.

It is very rare to have Psoriasis on the nails and nowhere else, so most people with nail psoriasis have psoriasis on other areas of the skin. 

Let’s take a closer look at a few other ways these nail issues are different.

Deciphering the Symptoms

Telling the two apart visually can sometimes come down to microscopic differences.

Let’s break it down

Along with the likelihood that you will experience symptoms like lesions and scaling on other areas of your body, psoriasis of the nails itself also has some standout features:

• Onycholysis: This is when the nail itself lifts away from the skin. When it is caused by psoriasis, there is often a streak of red under the nail right before the white portion. This resembles Psoriasis on the skin, with a red rash and white scales on top

• Pitting: Pits are small divots or dimples on the surface of the nail. In Psoriatic nails, the pits are irregular—some are larger, some are smaller, and they are scattered on the nail.

• Discoloration: You may have yellowish spots underneath the nail that look like drops of oil, as well as red or dark brown splotches on the nail itself from the white blood cells that flood the inflamed area.

• Thickening: Psoriasis can cause the skin under the tip of the nail to become thicker, just like the thick flakes that psoriasis on the skin causes.

• Bruising: Thanks to splinter haemorrhages, which are tiny bruises under the nails caused by trauma like smashing your finger, red or purple streaks under the nail may appear.

Nail Fungus

Usually (but not always) you’ll experience fungal infections in just one or two digits, as opposed to all five, and you’re most likely to see it on your feet.

Other common symptoms of nail fungus include:

• Discoloration: Nails can become detached, which causes major discoloration to the nail. You might notice yellow or white streaks and debris underneath the nail. The colour of the nail may darken, and the shape of the nail can progressively distort.

• Thickening: The nail, as well as the skin underneath it, thickens and will often be brittle and crack.

• Odor: Nail fungus is associated with a foul odor.

• Additional fungus: People with nail fungus may also have fungus growing on the skin of their feet (Tinea Pedis) This can show up as macerating white sogginess between the toes, flakiness around the edges of the feet, known as a Moccasin type presentation, flaking on the soles of the feet and tiny red blisters on the feet, or a combination.

Though the symptoms and appearance of nail fungus and nail psoriasis are similar, their root causes couldn’t be more different.

Here’s the lowdown: 

Nail fungus (Onychomycosis) is a curable infection that happens when your skin comes into contact with fungi and gets in between your nail and the nail bed.

Unlike psoriasis, nail fungus is highly contagious and can spread like wildfire. 

Often, nail fungus tends to hang around in warmer, moist climates.

Walking barefoot in wet, public areas like gym changing rooms, swimming pools, or in your garden/soil could lead to infection, particularly if you already have a cut, scrape or dry skin

Nail psoriasis on the other hand, is a chronic autoimmune-based skin disorder caused by inflammation.

Just like regular plaque psoriasis, nail psoriasis occurs when the skin cells experience accelerated turnover on and/or under the nail.

This can sometimes result in a buildup of skin cells under the nail, causing the pain or discomfort that some patients with psoriasis often experience.

In extreme cases, the buildup can result in the nail detaching from the nail bed entirely.

Psoriasis can affect any area of the skin—the skin near the nails as well as the area of the skin that grows the nail.

It does not affect the nails in everyone, but when the nails are affected by psoriasis, it increases the risk that the psoriasis will also attack the joints, causing psoriatic arthritis.