The relationship between damage from artificial nails and the development of psoriatic lesions is related to a well-known dermatological principle called the Koebner phenomenon.
Originally described in 1872, the Koebner phenomenon describes the formation of lesions due to micro-trauma to the skin. Whether the result of poor application, excessive filing of the nail bed, or even the removal of artificial nails/extensions with an aggressive technique, it leads to physical micro-trauma.
This injury can kick-start the inflammatory process in a genetically susceptible individual that rekindles a dormant psoriatic pathway. The nail matrix is a very vascular and immunologically active area of the body and provides a favourable area for psoriatic inflammation to plan.
What the doctor says about artificial nails and psoriasis
When we spoke to Dr Sonali Kohli, Senior Consultant – Dermatology, Sir HN Reliance Foundation Hospital, Mumbai, she said, "In my practice, I frequently see patients with only mild psoriatic tendencies, developing nail psoriatic changes as early as 2-4 weeks after aggressive nail manipulation. The injury is usually associated with nail pitting, oil-drop discolouration, subungual hyperkeratosis, as well as other identifiable signs that get missed as merely nail damage stemming from nails that have been negatively manipulated. "
In addition to mechanical trauma, the chemically-induced allergic or irritant injury from the nail glue, acetone or strong nail polish removers, UV-induced curing, etc., creates additional inflammation-based injury. Disruption of the nail's normal barrier function allows irritants to penetrate even deeper, facilitating inflammation-related damage.
Prevention tips for safe artificial nail use
- Select experienced nail technicians who are knowledgeable about sensitive conditions
- Choose a gentler application method
- Remove using non-acetone removers
- Keep nails hydrated with oils specifically designed for nail hydration
- Try breaks in between artificial nails
During outbreaks, utilise a comprehensive protocol that incorporates topical anti-inflammatory therapy combined with systemic support by means of medications, lifestyle changes to manage stress, specific supplements to help support the body's battle with flare-ups, and managing gut health. The sooner psoriasis is treated, in its early stages (i.e. local nail psoriasis), the less likely to develop into skin psoriasis.
The main message to patients is that cosmetic nail procedures are not harmful in and of themselves, but responsible decision-making and proper aftercare are required, particularly in patients with autoimmune predispositions.
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