My husband has psoriasis. How to treat nail discoloration?

Question

Hello doctor,

I am worried about my 42-year-old husband, who has been dealing with psoriasis for over 10 years. His condition started with small patches on his elbows and knees, but now it has spread to his back and scalp. He says the itching and flaking have worsened in the past few months, and he is now experiencing joint pain in his fingers and toes.

He used to get steroid creams in the past, but they do not seem to help much anymore. Recently, he also noticed his nails becoming pitted and discolored. He does not have a history of any other major illnesses, but has a family history of psoriasis (his mother had it).

Could you please suggest what could be done next? We are wondering if there is a need for any other effective treatment option at this stage.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

After reading your question, since your husband has a history of psoriasis with a positive family history. He has nail pitting with joint involvement and active psoriasis; he might be developing psoriatic arthritis, which should be treated with oral treatment (immunosuppressants) after laboratory investigations.

The small joints are more commonly involved in psoriatic arthritis, and if left untreated, can result in deformities.

For local skin psoriasis, the first line of management is the application of bland moisturizers three to four times a day.

Over flaky patches, corticosteroid ointments like Clobetasol propionate or Halobetasol can be used once daily for three weeks (five days per week) with two days off.

A good shampoo with Ketoconazole, with Salicylic acid one to two percent, three times per week, will help if the scalp is involved.

Kindly follow up with me after seven days.

I hope this helps.

If you have more concerns, feel free to reach out to me anytime.

Thank you.