Nail fungus and nail psoriasis are two conditions that affect the nails. They have similar symptoms, and you can have both fungus and psoriasis at the same time, but they are different and have separate treatments.
Nail fungus is an infection that happens when fungi get under your nail. The fungus turns nails thick, discolored, and brittle. Onychomycosis is another name for nail fungus.
Nail psoriasis is an autoimmune disease in which skin cells multiply too quickly. Like nail fungus, psoriasis causes discolored, pitted nails. Most people with nail psoriasis also have scaly skin rashes, and they sometimes have joint pain called psoriatic arthritis.
Both fungus and psoriasis can affect the nails on your fingers and toes. But nail psoriasis is more likely to be on just the fingernails, and fungus is more likely to affect the toenails.
You can't catch nail psoriasis from someone else or spread it to other people. Nail fungus is contagious – it can spread from one person to another.
Nail Fungus vs. Psoriasis Causes
Fungi cause nail fungus. This group of tiny organisms includes mold, yeast, and mildew. A type of mold called a dermatophyte causes the most common fungal nail infection, tinea unguium.
You can pick up fungus if you walk barefoot in places where other people walk, like swimming pool decks and locker rooms. Fungi can also grow in wet shoes. Once these organisms are on your feet or hands, they can get under your nail and multiply. Athlete's foot is a fungal infection that sometimes spreads from the foot to the toenails.
You're more likely to get nail fungus if you:
- Are over age 60
- Have diabetes
- Have a weak immune system from a disease like HIV
- Have a problem with blood circulation because of peripheral vascular disease
- Have a cut or other injury on your nail
- Have had athlete's foot
Psoriasis is an autoimmune condition. Your immune system overreacts and causes inflammation in your skin that speeds up the production of new skin cells. The extra cells build up on your skin and form scaly patches. Psoriasis inflammation can also affect the nails, causing symptoms like pitting, thickness, and color changes. About half of people with psoriasis have nail psoriasis, and up to 90% will have nail problems at some point in their lives.
Nail fungus and nail psoriasis can look similar, and they sometimes overlap. Having psoriasis makes you more likely to get a fungal nail infection. That's because psoriasis damages the nails and makes it easier for fungi to get underneath them. Some of the medicines that treat psoriasis weaken your immune system and lower your body's defenses against fungi and other germs.
Nail Fungus vs. Psoriasis Symptoms
Both nail fungus and nail psoriasis change the color and texture of your nails. Nails with fungus may be:
- Thick
- Cracked or crumbling
- Yellow, white, or brown
- Misshapen
- Lifted up from the nail bed (the skin under the nail)
- Painful
- Smelly
Nails with psoriasis may be:
- Dented or pitted
- Covered in grooves called Beau's lines or brown spots called oil spots
- Thin and crumbling
- White, yellow, red, pink, or brown
- Separated from the nail bed (you can see the skin underneath)
The color changes might look different on dark skin, especially in people who have psoriasis. Instead of looking red, the psoriasis rash may be purple or brown with silver flakes.
Subungual hyperkeratosis
This condition can affect people with nail psoriasis and nail fungus. Subungual hyperkeratosis happens when psoriasis scales or keratin – a protein in the skin – collects under the nail. These substances thicken the nail and push it up. If subungual hyperkeratosis is in your toenails, your shoes might hurt when they press on the damaged nail. You could also see blood under the nail.
Onycholysis
Onycholysis is when a fingernail or toenail peels off from the nail bed. It can happen if you have nail psoriasis or nail fungus, but it also affects people who have nail injuries or the skin condition lichen planus (inflammation that causes a rash). Onycholysis starts with a white or yellow patch at the tip of the nail. The patch grows down until it reaches the cuticle. Bacteria may grow under the nail and turn it green. The nail can also become infected.
Nail Fungus vs. Nail Psoriasis Diagnosis
A primary care doctor, dermatologist (skin doctor), or podiatrist (foot doctor) can diagnose these nail problems. The doctor will examine your nails for symptoms like nail pitting, discoloration, crumbling, and separation from the nail bed. They may ask about your medical history, including whether you've had symptoms of psoriasis or psoriatic arthritis.
The doctor might clip off a small piece of the nail or take a scraping of material from under your nail. Then a lab will look at the sample under a microscope to see if you have an infection. They might also let the sample grow in a special dish to find out what type of fungus caused the infection.
If your doctor isn't sure whether you have nail fungus or psoriasis, they may remove a small piece of tissue from the nail bed, called a biopsy. A lab will look at the biopsy sample under a microscope to confirm the diagnosis.
Doctors assign nail psoriasis a score based on how serious its symptoms are. A low score means you have mild nail psoriasis. A high number means it’s more severe.
Nail Fungus vs. Nail Psoriasis Treatment
Antifungal medicine treats nail fungus. You either apply this medicine to your nail (topical) or take it as a pill.
Psoriasis has many treatments. Some work on your nails directly. Others treat psoriasis throughout your body.
Antifungal medicines
Topical antifungal medicines for nail fungus include:
- Ciclopirox (Penlac) medicated nail polish
- Efinaconazole (Jublia) cream
- Tavaborole (Kerydin) cream
You put topical medicines on your nail every day to stop new fungus from getting in. Once the nail grows out, the fungus should be gone. This process can take time. Fingernails regrow in 4 to 6 months. Toenails take 12 to 18 months to fully grow out.
The most common side effects from topical antifungal medicines are:
- Redness
- Swelling
- Stinging or burning when you apply the medicine
- Ingrown toenail
Oral antifungal medicines work faster. They can clear the infection within two to three months. Antifungal pills include:
- Fluconazole (Diflucan)
- Griseofulvin (Grifulvin)
- Itraconazole (Sporanox)
- Terbinafine (Lamisil)
Antifungal pills can cause side effects like a rash and liver problems.
For a stubborn infection, you may need both an oral and topical antifungal medicine. When you combine the medications, they work better. You may need to use them every day for four months or longer to see improvement.
Rarely, antifungal treatments won't clear up a nail infection. If your nail fungus doesn't improve on medicine, your doctor may remove the nail with chemicals or surgery. The nail eventually will grow back.
Topical nail psoriasis treatments
For mild nail psoriasis, your doctor can prescribe one of these topical medicines that you apply directly to your nails:
- Corticosteroid cream
- Calcipotriol (Dovonex, Sorilux)
- Tazarotene (Tazorac)
You may have to use these medicines once or twice a day for six months or longer to see an improvement. Corticosteroids also come as an injection into your nail once every four to six weeks. You get these shots at your dermatologist's office. Some psoriasis medicines are also given as an injection in or around the nail. You may get a shot in your stomach or thigh to work systemically (throughout your whole body).
For moderate to severe nail psoriasis, your doctor may prescribe a systemic medicine. They come in a pill or as an injection/infusion into a vein:
- Acitretin (Soriatane)
- Apremilast (Otezla)
- Biologic drugs like bimekizumab (Bimzelx), guselkumab (Tremfya), ixekizumab (Taltz), risankizumab (Skyrizi), and secukinumab (Cosentyx)
- Cyclosporine (modified), deucravacitinib (Sotyktu)
- Methotrexate
These medicines can cause reactions where the needle goes in, headache, rash, and an increased risk of infections.
Nail fungus vs. nail psoriasis home remedies
You may be able to manage nail fungus at home with over-the-counter antifungal creams like terbinafine (Lamisil). First apply a cream that contains urea to soften your nails. Then trim them and thin them out with a nail file to help the medicine penetrate more deeply into the nail.
Some people try natural remedies like these to treat nail fungus:
- Tea tree oil. This essential oil kills the fungi that cause nail infections. In one study, tea tree oil worked as well against nail fungus as an antifungal cream.
- Chest rub. Ingredients like camphor and eucalyptus oil in medicated chest rubs like Vicks may help with nail fungus, according to a couple of small studies.
- Vinegar and mouthwash. Some people have mixed apple cider vinegar or antiseptic mouthwash with water to treat nail fungus. This mixture hasn't been proven to work, but it isn't harmful to try.
A few natural remedies may be helpful for nail psoriasis:
- Indigo naturalis oil
- Omega-3 fatty acids
- Wheat germ oil
- Flaxseed oil
Nail Fungus vs. Nail Psoriasis Prevention
Even after you've treated nail fungus, you can get it again. To avoid these infections:
- Wear flip-flops, shower shoes, or sandals when you walk in public areas like gym or spa locker rooms or pool decks.
- Wash your hands and feet with soap and water every day. Dry them completely and apply a moisturizer. Use an antifungal powder too.
- Put on a clean pair of socks every day. Choose fabrics that wick away moisture, like acrylic. Change your socks whenever your feet sweat.
- Wear shoes made from breathable fabrics like canvas, mesh, or leather.
- If your shoes get wet, let them dry for at least 24 hours before you wear them again.
- Keep your fingernails and toenails short to prevent fungi and other germs from getting under your nails.
- Don't share nail clippers, shoes, and other personal items with other people.
- After you treat a fungal nail infection, throw out your shoes or clean them with a power sanitizer.
- Only get manicures and pedicures in places that are clean, licensed, and that sterilize their tools.
- If you get athlete's foot, treat it to prevent the fungus from spreading to your toenails.
You may not be able to avoid nail psoriasis, but there are ways to protect your nails if you have this autoimmune disease:
- Avoid psoriasis triggers like sunburn, bug bites, stress, and exposure to cold air.
- Take the medicine your doctor prescribed to keep psoriasis under control.
- Keep your nails trimmed short. This will prevent debris from building up under your nails.
- Wear gloves when you do things like gardening or washing dishes, and when you handle cleaning products and other chemicals, to avoid irritating your hands.
- Wash and moisturize your hands and feet every day.
- Don't bite or pick at your nails. You could get an infection that triggers a psoriasis flare.
- Don't wear fake nails. They increase the risk of your nail separating from the bed.
Takeaways
Fungal infections and psoriasis both affect the nails. They may cause similar symptoms, and it's possible to have both conditions at once.
Nail fungus and psoriasis are treated in different ways. Antifungal medicines treat nail fungus. Psoriasis treatments include corticosteroids, biologic drugs, and methotrexate. Your dermatologist or podiatrist can recommend the right treatment for you. Keeping your nails trimmed, clean, and moisturized will protect your nails against fungus and psoriasis.
Nail Fungus vs. Nail Psoriasis FAQs
Does nail fungus go away?
Antifungal medicines can clear up nail fungus, but it could take a few months. Because nail fungus can come back, it's important to keep your nails trimmed and clean.
What are the early signs of nail psoriasis?
The early symptoms of nail psoriasis include small dents or pits in the nails, a change in nail color, and a buildup of debris under the nail.
What happens if you put antifungal cream on psoriasis?
An antifungal cream won't clear up psoriasis, but it can treat nail fungus if you have both conditions. Avoid the antifungal pill Lamisil if you have psoriasis, because it could make your symptoms worse.
Can you have a fungal infection and psoriasis at the same time?
Yes, you can have nail fungus and psoriasis at the same time. But each condition requires a different treatment.
