Psoriasis Nail Care

Not everyone has the time or the inclination to spend lots of time grooming their nails. But experts say nail care is more than an exercise in vanity. Without the proper attention, irritating and sometimes painful problems can develop, including ingrown nails and persistent fungal infections. And nails can sometimes reveal that someone is suffering from an underlying illness.
Below, Darryl Haycock, DPM, a spokesperson for the American College of Foot and Ankle Surgeons, explains what you need to do to keep your nails healthy.
What are the different parts of the nail?There is the cuticle at the base of the nail and then a whitish area that's called the lunula. Then you have the nail plate itself, which grows out on a nail bed.
Why do we have nails?It's felt that it's an evolutionary leftover. A lot of animals have claws, and nails were a means of allowing us to use our fingers and toes to grab things and hold onto things. Basically it helps stabilize the end of the finger or toe.
What should a healthy nail look like?A healthy nail should look smooth. It should look pink in coloration and the white portion near the cuticle should be nice and clear, and it shouldn't be excessively thickened. In the drier weather, however, you'll get more cracking and hangnails.
Are nail problems ever a sign of a medical illness? There are a lot of medical illnesses that are diagnosed through the fingernails or toenails. These include nutritional deficiencies, such as calcium and protein deficiencies, and diseases like psoriasis, which can cause a pitted look and white discoloration.
It might be lichen planus, which is basically a thickening of the skin. White spots under the nail are usually due to some kind of trauma, or injury. Sometimes even you can see a malignant melanoma, a type of skin cancer, as a black discoloration underneath a nail. That doesn't mean that every black discoloration is a cancer; sometimes those are just normal changes in the nail color.
What causes ingrown nails?Ingrown nails have a number of different causes. Some people have a lot of thick skin around the nail itself, and it's hard for the nail to grow out through that thick skin. Some people have nails, particularly toenails, that become curved, almost like an old covered wagon that buckles around and pinches in. Trauma such as having the nail stepped on can also cause ingrown nails by putting pressure on the nail and forcing it to grow into the skin; this causes a cut between the side of the nail and the skin, which can become infected and irritated.
Trimming the nails poorly can cause ingrown nails. We see a lot of ingrown nails in teenagers. It seems that teenagers who are going through a rapid growth spurt also have faster-growing nails, so they need to cut their nails more often.
How can you prevent and treat ingrown nails?Just try to cut your nails properly. It's recommended that you go straight across. If you prefer to cut in a curved fashion on the corners, you can do that, but you have to be aware that you have to frequently trim your nails in the corners so the nail doesn't grow into the skin. Be careful not to pull any thickened skin that may grow in the corner of the nails but to clip them. If you get a cut in the side of your nail as you're doing that, it's important to disinfect that area. Put an antibiotic ointment on there to keep it nice and moist, and to give it a chance to heal up. If it does become infected, then it's probably going to be best to see your podiatrist or dermatologist about it.
What about blood under the nail? Blood underneath the nail is usually from a trauma, such as if someone drops something or sets a table leg on their toe, or crushes or pinches their finger.
People can have shoes that are too short or too small for them, so when they walk or run, the toenail is continually driven into the end of the shoe. This is what we call microtrauma; the toenail can either separate off completely or it can cause a build up of blood underneath that toenail. We see it a lot in soccer players and distance runners. It is also common in ballet dancers who wear pointe shoes. Likewise, typists who have long nails may have microtrauma to their fingernails from chronically hitting the keys.
If the area with the blood clot is painful, we'll try to relieve the pressure by drilling a hole in the nail and allowing the blood underneath the nail to come out.
How do you identify and treat nail fungus?It can start in several different ways. But usually it appears as a yellow, brownish discoloration of the nail. It usually starts at the end of the nail, then works its way back underneath the nail. It makes the nail thick, yellow, crumbly. Sometimes you'll see yellow streaks on the nail as the fungus progresses.
Nail fungus tends to be resistant to cure with most topical ointments and creams. The only one that's been approved by the Food and Drug Administration for treatment of nail fungus is ciclopirox, a nail polish-like material that is brushed on. There are also oral medications, or, if the nail has been completely deformed or thickened or is painful, it will sometimes be removed.
Is it possible to get a fungal infection from a manicure or pedicure? If someone has a manicure or pedicure from an establishment that does not properly clean instruments a fungus could spread from person to person.
What should proper nail care involve? Examine your nails and frequently trim them. If they get too long, they can cause a number of other problems from being torn to being completely lifted off because the nail catches on something.
Don't push the cuticle back all the time. The cuticle is actually a nice barrier that keeps infection from coming into the nail. You might need to slide it back a little bit, but you have to be careful about pushing it too hard.
As far as putting anything onto the nails, it's tough to say whether that has a real benefit. I know some people have a natural split in their nails, and they'll put superglue in that split and that seems to help keep that from splitting and giving them problems.
Nail polish does strengthen the nails a bit and doesn't seem to create problems. But if you put on too much, it will stain your nails. And nail polish covers up your ability to see your nails and see if they're healthy. Nail polish remover may dry the nails.

Psoriasis Is A Cause Not A Result Of Obesity

While obesity among people with psoriasis is common, being overweight does not cause the disease, as previously thought, a recent study shows. Instead, U researchers found that the disease actually causes patients to become overweight. They also found that people with psoriasis are more likely to have a weight problem after developing the autoimmune skin disease.The researchers published their findings in the December issue of The Archives of Dermatology. Researchers studied 557 patients from the Utah Psoriasis Initiative, which was formed to help find causes of the disease and to link symptoms and traits in order to better understand psoriasis. U researchers are also looking at the correlation between smoking and psoriasis. They reported that 36 percent of the patients studied were smokers and that smokers are more likely to develop psoriasis. About 2.5 percent of people in Utah are affected by psoriasis, which most commonly produces painful lesions on the skin.Among the researchers is Gerald Krueger, professor of dermatology, who recently received a Presidential Chair award.

Advitech To Market Psoriasis Supplement in The U.S.

Quebec-based Advitech said today it has reached an agreement with US company PhotoMedex to market and distribute its whey-derived psoriasis supplement in the US.The Canadian biotech firm has recently signed a deal for the product, called Dermylex, to reach the French market and said it expected further distribution to follow on quickly.
PhotoMedex, which sells products for skin health through its own sales force directly to dermatologists, cosmetic surgeons, and spas, intends to trial the product during the first quarter of 2006 in selected locations. If the market develops well, it will roll-out the product in all its sales locations in the United States in the second half of the year.
Although a dietary supplement, Advitech is targeting pharmaceutical distributors to increase awareness of its product. Last year a phase 2 clinical trial of the active ingredient, XP-828L, confirmed the efficacy and safety profile of the product for patients with mild to moderate psoriasis.
Renaud Beauchesne, chief executive of Advitech, said PhotoMedex's sales organization and access to dermatologists would allow the product to be positioned very well in the important US market.
Prior to a nationwide roll-out Advitech will sign over exclusive rights to PhotoMedex to market products using Dermylex in specific US market segments.
The contract will extend over several years, and will provide for certain minimum level of purchase of products to be negotiated between PhotoMedex and Advitech. Other terms and conditions of the Agreement were not disclosed.

Discovering The Trigger For Psoriasis

An immune molecule that normally assists in cell “suicide” may be an important trigger in the development of the common skin disease psoriasis, according to scientists from the Technion-Israel Institute of Technology and State University of New York, Stony Brook.
The culprit, a molecule called Fas, acts as a middleman between activated immune cells and a handful of inflammatory hormones involved in psoriasis flare-ups, say Technion researcher Dr. Amos Gilhar and colleagues. The study appears in the January, 10 2006 American Journal of Pathology.
Psoriasis is a non-contagious, lifelong skin disease that usually appears as scaly and inflamed patches of skin, although it can take several different forms. In patients with psoriasis, the white blood cells that make up the body’s immune defense system go into overdrive, triggering other immune responses that pile up skin cells at an abnormal rate.
Current treatments for psoriasis such as the drug Enbrel focus on these inflammatory hormones, but the researchers were able to stop the development of psoriasis in mice long before these hormones came into play by injecting an Fas-blocking antibody.
“The finding that antibodies to Fas can prevent psoriasis further demonstrates the complexity of the disease and its numerous molecular pathways,” Gilhar says.
Dr. Alice Gottlieb, chair of the Clinical Research Center at the Robert Wood Johnson Medical School in New Jersey agrees. “This research shows that activation of the Fas pathway is important in starting the ball rolling in psoriasis,” comments Gottlieb (who was not involved with this study). “These findings could have implications for other immune diseases such as rheumatoid arthritis and Crohn's disease,”
The researchers suspected that the Fas molecule was in the middle of this process, since it is found at high levels in psoriatic skin and leads an intriguing dual life. Most of the time, Fas guides the normal process of cell suicide called apoptosis. But in cells where apoptosis is blocked by other molecules, as it is in psoriatic cells, Fas switches roles and encourages the production of common inflammatory hormones instead.
To figure out exactly where Fas stood in the development of psoriasis, Gilhar and colleagues transferred grafts of clear, non-involved skin from human psoriasis patients to mice. They injected the mice with white blood cells bearing the Fas molecule on their surfaces to jump-start the formation of psoriatic skin lesions.
By blocking Fas action with a special antibody, the researchers were able to show that Fas actually is the key middleman in psoriasis formation. Without Fas, the natural killer cells were unable to trigger the production of the inflammatory hormones that lead to the characteristic skin thickening and other signs of psoriasis.
There is some evidence that Fas is involved in other skin conditions such as eczema, so future treatments targeting the Fas pathway may prove useful for a variety of diseases, suggests Dr. Richard Kalish, Gilhar’s collaborator from SUNY Stony Brook. However, researchers need to develop a human antibody to Fas before the technique could be tested in people.
“The current study is one of the many wonderful papers that have come out of this very productive collaboration across many miles between Dr. Gilhar and Dr. Kalish,” says Gottlieb.
According to the National Psoriasis Foundation in the United States, 1-3 percent of the world’s population suffers from psoriasis. About 30 percent of people with psoriasis have severe cases, where the affected skin covers more than 3 percent of their body. In some people, the disease is associated with a form of arthritis.
The Technion-Israel Institute of Technology is Israel's leading science and technology university. Home to the country’s winners of the Nobel Prize in science, it commands a worldwide reputation for its pioneering work in nanotechnology, computer science, biotechnology, water-resource management, materials engineering, aerospace and medicine. The majority of the founders and managers of Israel's high-tech companies are alumni. Based in New York City, the American Technion Society is the leading American organization supporting higher education in Israel, with 17 offices around the country.

Managing Psoriasis In Winter

Fall and winter can be the toughest times of year for people with psoriasis and/or psoriatic arthritis.

A combination of dry air, decreased sunlight exposure, and colder temperatures all contribute to psoriasis getting worse in the winter. Frequent moisturizing and using a home humidifier can help alleviate some of the symptoms. Also, discuss treatment such as UVB or home phototherapy with your doctor.

Anything that can affect the immune system can, in turn, affect psoriasis. Having a cold or the flu can definitely play a role in your psoriasis. Make sure you get plenty of rest, wash your hand frequently, and try to be aware of other triggers in your life, such as stress, that can increase your susceptibility to sickness.

One form of psoriasis called guttate is often associated with strep throat. A microorganism called Streptococcus causes strep infections. Many times a person may not even have symptoms of strep throat but still have an active flare of psoriasis. Talk with your doctor about getting a streptococcal antibody test to determine higher than normal levels of strep in your system.