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Husband’s Nails are Corrupt and Not Growing
from Tand B.

Ed:  My husband has psoriasis.  Not so bad on the skin.  He says it doesn’t bother him, but his nails aggravate him to no end. 

A general physician said it was nail fungus.  The dermatologist says it is psoriasis in the nails.  His nails are very brittle and crack and split all year round.  Not just in the Winter. 

He's tried everything from nail hardening polish to cortisone shots under the nails. 

They don't really grow so the cracks never seem to grow out.  I haven’t seen this mentioned in the letters.  Is there a specialist that really has any experience with this?  Do you have any advise?  -Tand B.

P.S.  It is his finger nails not his toenails that really bother him.

*****

Ed’s Response:  That’s a tough one, Tand.  I know of no “nail P specialist.”  The derms I’ve heard address the problem all agree that it’s difficult to treat and, even when you’re on the road to recovery, the road is much longer for nail P than for other forms of P.

To be brutally honest, my nails have never cleared except when I’m on a systemic — methotrexate or cyclosporine.  When I stop taking these, nail P invariably returns.

If your husband’s nails really didn’t grow, I imagine he’d have lost the nails by now, because P will have turned them into a softer, crumbly tissue under the very thinnest veneer of hardness — a veneer that time and day-to-day erosion would have worn away.  More likely the nail is being replaced from the cuticle outward, but slowly, and with continuous corruption from the P. 

Most of the normal palliative therapies, including cortisone injections, will not change the already corrupted nail, but they are intended to start a normal growth that you will see gradually push out the bad nail.  Problem is for me, and probably for your husband, too, none of those palliative remedies really work to get our good nails started.  The bad just keeps generating more bad.  (If I had the means and constitution to take ultra-slow time lapse photography — like a frame a week for a decade or so — I’m sure I could create a real horror show when I speed up the wave like corruption of a fingernail victimized by P.)

Some people have had their nails removed and replaced with artificial nails.  I’ve read this; never seen it.  I have my doubts.  But thought you should know.

Once, years ago, a derm suggested I remove my thumb nail by using a nasty formula under an occlusive dressing for two weeks.  This was supposed to dissolve the nail so it could be wiped away when the dressing came off.  Theory was that with the bad nail totally gone, the chances of growing a good nail in its place would be improved.

I never got to test the theory because the nasty compound and two weeks of occlusion were insufficient to remove the nail.  What I ended up with was a corrupt nail that now had the constituency of rubber.  In time it toughened back up.  And continued to look uglier than sin.

You may also want to search on “diet” and browse through some of the correspondence here.  There are vitamins and dietary supplements known to stimulate healthy nail growth.  Maybe just speeding up the growth of your husband’s nails would help.  My mother would say, “Eat a lot of Jell-O.”

If anyone else reading this has some tips on treating P nails, please share. 

Meanwhile, Tand, best of luck.  -Ed

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