The bumpy spots on the nails

It is very common to have small bumpy spots on the nails in daily life. This will not only seriously affect the patient's image, but also cause certain harm to their physical health. Therefore, it is particularly important to understand the cause and find scientific and effective treatment methods. People need to pay attention to this situation. It may be psoriasis, and they should seek medical treatment in time and take external medications for treatment.

1. The small bumps on the nails may be psoriasis

Psoriasis can cause nail damage due to invasion of the nail plate. Early damage appears as pits and bumps, which is academically called thimble-like changes. If it is not cured in the early stage, it will further damage the nails, making the nail plate uneven and losing its luster. Sometimes the nail plate will have longitudinal ridges, transverse grooves, turbidity, hypertrophy, the free end will be separated from the nail bed, or the entire nail plate will be deformed or absent, and sometimes it will show onychomycosis-like changes. But this is not onychomycosis, there is a big difference between the two.

2. Introduction of the disease

Psoriasis is a very common skin disease, but it is not easy to treat. Psoriasis varies greatly, and a small part of it manifests itself on the nails. The nail damage caused by this type of psoriasis is very similar to onychomycosis, but there are differences between the two. Onychomycosis is caused by fungi, and usually starts from the toenails. The front end of the nails often appears to be rough wood eaten by insects, and filamentous debris can be pinched out with tweezers. It usually develops and worsens in the summer. After the application of antifungal drugs, onychomycosis should improve significantly and then heal. The nail damage caused by nail psoriasis is not caused by fungi, but is caused by excessive subungual keratinization. It usually starts from the fingernails and is generally relatively relieved and alleviated in the summer. Even with the application of antifungal drugs, there will be no obvious improvement. It is still recommended not to use them.

Treatment

There is currently no specific treatment for this disease, but it is not incurable. Appropriate symptomatic treatment can control symptoms. Since this disease is a chronic recurrent disease, many patients require long-term treatment, and various therapies have certain adverse reactions. The main ones include combination therapy, alternation therapy, sequential and intermittent therapy.

1. Topical medication

For new skin lesions of small area, use topical medications as much as possible. The concentration of the drug should be increased from low to high. The choice of medicine should be based on the properties of the medicine itself and the patient's specific condition.

(1) Vitamin D3 analogs: This class of drugs includes calcipotriol, tacalcitol, etc., which are effective in treating plaque psoriasis. Calcipotriol cream, ointment, and lotion (for the head) are applied twice a day. They usually become effective within 8 weeks and do not cause dependence with long-term use. This drug can be used in combination with corticosteroids or UVB to improve its effectiveness. It should be used with caution in patients with bone disease, calcium metabolism disorders and renal insufficiency to avoid causing hypercalcemia.

(2) Topical glucocorticoids are still the commonly used treatment for psoriasis. Strong hormones are suitable for the head and palms and soles, while weak hormones are suitable for the face and intertriginous areas. Ointments and creams are commonly used for general areas. For the head, solutions (propylene glycol) and gels are used. Local occlusive therapy can significantly increase the intensity of the effect.

The effect of glucocorticoids on skin lesions is temporary. The initial therapeutic effect is significant, and sudden discontinuation of the drug often results in a "rebound" phenomenon. Those who need long-term medication should adopt intermittent treatment, that is, apply it once every 2 to 3 days. Combination use with other drugs (such as vitamin D3 analogues, retinoic acid, etc.) is beneficial to consolidate the therapeutic effect and reduce adverse reactions.

(3) Anthralin is often used for chronic plaque psoriasis. It can be formulated into ointments, pastes and paraffin preparations. The commonly used concentration is 0.05% to 1.0%. Start with a low concentration and gradually increase it according to the patient's tolerance. Do not use on face and intertriginous areas, be careful to protect normal skin. The lesions usually begin to subside after 2 to 3 weeks.

(4) Retinoic acid gel and cream (0.05% to 0.1%) applied once or twice a day are effective for psoriasis. Because of its slow onset of action, it is generally not used alone as a first-line drug. It can be used in combination with glucocorticoids such as clobetasol propionate. After the skin lesions are controlled, continue to use tazarotene and gradually stop using glucocorticoids. It is forbidden to use for pregnant women, breastfeeding women and women who want to have children in the near future.

(5) Commonly used tars include coal tar, pine oil, bran oil and black bean oil, which are prepared into 5% concentration ointment for external use. Coal tar is effective for chronic stable psoriasis, scalp psoriasis and palmoplantar psoriasis. Contraindicated in pregnant women, pustular and erythrodermic psoriasis. There are now colorless, odorless preparations of coal tar that approach the effectiveness of the crude product. Soluble coal tar can be used for bathing, and coal tar shampoo can be used for washing hair. Coal tar spirit is effective for applying to the head and for treating psoriasis.

(6) Other topical medications such as immunosuppressants, such as tacrolimus, pimecrolimus topical treatment, and occlusive treatment for refractory localized psoriasis. 0.03% camptothecin ointment, 5% salicylic acid ointment, etc.

If your nails suddenly develop pits and bumps, be sure to identify whether you have psoriasis.