When country singing sensation LeAnn Rimes admitted late last year that she has struggled with psoriasis since childhood, she opened many people’s eyes to the physical and emotional toll the condition can take on a person. Psoriasis not only presents cosmetic issues—often leading to avoidance of social interaction and heightened self-consciousness—but it also affects the sufferer’s physical well-being and level of comfort.
Psoriasis is a chronic autoimmune disease that appears on the skin, and occurs when the immune system sends out faulty signals to speed up the growth cycle of skin cells. Symptoms of psoriasis frequently appear on the hands, feet and nails, so nail technicians should be aware of this disease and how it can affect salon services. In this month’s Nail Clinic, we delve into the details about this relatively common condition and discuss ways to accommodate clients with psoriasis in the salon.
A Psoriasis Primer
While the exact causes of psoriasis have yet to be discovered, like many diseases, genetics plays a major role in its development. “Psoriasis is an inherited skin disease in which the skin proliferates much faster than normal,” says Robert T. Brodell, MD, professor of internal medicine, dermatology, at Northeastern Ohio Universities College of Medicine in Rootstown, Ohio. “If you have a family member with psoriasis, you have an increased risk, but since something can set it off without warning, you may have no way of knowing whether it runs in your family.” In other words, a family member who actually carries the gene may have never experienced a triggering event, so the problem remains latent for one or more generations.
According to Joel Schlessinger, MD, FAAD, FAACS, Omaha, Nebraska-based board-certified dermatologist and cosmetic surgeon, and president of
If your client has psoriasis, there is a good chance that her nails will be affected along with her skin, so you should be ready to counteract some typical symptoms that occur. "Nail changes occur in up to 50% of people with psoriasis, and at least 80% of those with psoriatic arthritis," says Bosland. Common nail changes in clients with psoriasis include:
Psoriasis is also closely linked to fungal infections. "Some patients have the psoriasis process—scaling and inflammation—occurring at the base of the nail (where the new nail is formed) and nail psoriasis may be present with any type of psoriasis," explains Brodell. "But it’s important to distinguish psoriasis from yeast-induced fungal nails or dermatophyte-induced athlete’s foot."
Bosland explains that because psoriasis of the nails can present with fungal infections, it can be difficult to tell which is which. "About one-third of people who have nail psoriasis also have a fungal infection," she adds. If there are any doubts, a dermatologist can pinpoint the problem through one or more simple tests—and keep in mind that it's not part of a nail technician's job to diagnose medical problems.
To help your clients who suffer from psoriasis, Bosland recommends that nail techs keep nails trimmed as short as possible so as to avoid trauma to the nail, which can worsen or trigger nail psoriasis. Cosmetic repairs can also help offset the nails’ unpleasant appearance. Service options include: filing the nails down to counteract the thickening and using a ridge-filling base coat to help with the pitting. Other options include applying nail polish to mask imperfections or applying short enhancements to reinforce the natural nail.
There is no doubt that psoriasis can take an exacting physical and emotional toll on a client’s well-being and self-esteem, but you can take an active part in helping her through this often sudden and unpredictable disease by making her feel beautiful at a time when she may feel less than her best. Whether your client has a mild or severe problem, listen to her concerns, be sensitive to the changes in her skin and nails, and when in doubt, have her ask her doctor about what nail services are acceptable. Because this disease is different for every person, examine each client on a case-by-case basis. With a little extra attention and customization, you’ll do wonders to improve her entire outlook, both at your salon and in her daily life.
Tracy Morin is a freelance writer and editor based in Oxford, MS.
Psoriasis appears in a variety of forms with distinct characteristics. Typically, an individual has only one type of psoriasis at a time. Aimee Bosland, health educator for the National Psoriasis Foundation in Portland, Oregon, describes the five main types of psoriasis and their common symptoms:
Plaque psoriasis (psoriasis vulgaris) is the most common type. It leads to raised, inflamed red lesions covered by a silvery white scale, and is found on the elbows, knees, scalp and lower back.
Guttate psoriasis starts in childhood or young adulthood. It often comes on suddenly; materializes on the trunk and limbs; and appears as small, red individual spots on skin.
Inverse psoriasis appears in the armpits, groin, under the breasts and in other skin folds. It creates bright red lesions that are smooth and shiny, and is subject to irritation from rubbing and/or sweating.
Pustular psoriasis is seen primarily in adults. It’s characterized by white blisters of noninfectious pus surrounded by red skin, and may be either localized or spread over the body.
Erythrodermic psoriasis is particularly inflammatory and affects most of the body’s surface. It’s characterized by periodic, widespread fiery redness of skin and the shedding of scales in sheets rather than flakes, and is often accompanied by severe itching and pain, heart rate increase and fluctuating body temperature. (Note: A client who experiences these symptoms must see a doctor immediately and may require hospitalization.)