The main manifestations of nail psoriasis include hyperkeratosis under the nail, separation of the nail, nail acrochordon, and crumbling or flaking of the nail.
Nail psoriasis occurs when psoriasis involves the nail and causes nail changes. The clinical manifestations of nail psoriasis are related to the site of involvement, and when the nail bed is involved, it can lead to subungual hyperkeratosis. The nail plate may become deformed, thickened, brittle, and in severe cases, there may be separation of the nail with oil droplet-like coloration.
When the nail matrix is involved, it can lead to nail thimble-like changes, i.e., the nail plate appears to have punctate depressions that resemble thimble hoops. In some people, transverse or longitudinal stripes are seen on the nail, i.e., transverse nail striae or longitudinal nail ridges. Involvement of the nail folds can occur nail fragmentation or even nail peeling.
Specific clinical manifestations have some individual differences, and need to be diagnosed by specialized doctors.