Nail Psoriasis vs Fungus – How to differentiate between the two?

lichen-planus-nails_(1)Nails are one part of our body that every female wants to flaunt. Be it with eye catching nail colors or trendy nail art. On the other hand, many times, the health of the nails are overlooked considering it as a unimportant part of our body. But being negligent about them can be very nasty and painful.

Nail affections:

Negligence can lead to various infections of the nail and the nail bed. The infections can be in the form of a simple infection (called Paronychia, often due to sharp nail clipping), a fungal infection or psoriasis. Nail psoriasis is uncommon but many a times it resembles a fungal infection. It becomes hard to differentiate and diagnose between toenail psoriasis vs fungus.

Nail Psoriasis:

Psoriasis is an auto immune disease. It tends to produce scaling (peeling), redness and itching on the skin. If you already are suffering from psoriasis, you are at risk of developing psoriasis of the nails. 50% of those who are affected by psoriasis are thought to have nail involvement too. For unknown reasons, finger nails are more commonly affected than toenails. In rare cases one may find psoriasis affecting the nails first. At that time it may be difficult to differentiate between the two.

Features to distinguish Nail psoriasis vs Fungus:

Psoriasis of the nails can be triggered following any trauma or injury to the nails (koebner’s phenomenon) as seen in psoriasis of the skin.

Fungus of the nails or onchyomycosis is caused by a fungus causing infection. There are some factors which predispose one to contract fungal infection of the nails. The most important factor which favors fungus is warm climate. Fungus grows well in a warm and humid climate. Hence it is mostly found in people who sweat a lot, individuals who love swimming and do not dry their body properly (Especially the spaces between the toes).

The two can be differentiated by the appearance, as psoriasis has a classical yellow nail pitting (indentation) which is not found in any fungal infection.

The yellow pitting in psoriasis and hyper pigmentation (dark discolouration) in case of fungus can be the strong differentiating points.

Fungal infection usually spreads from the toes (Tenia pedis or athletes foot), to the inter-digital spaces followed by spread to the nails. It starts with a small yellow dot beneath the nail. In fungus infection there is a foul odor with dull appearance of the nails.

Psoriatic nails gradually tend to get separated from the nail bed (oncholysis) whereas the fungal nails just get deformed. There is a chalky appearance under the nails which lifts up the nails which further causes pain and tenderness.

Tests for diagnosing toenail psoriasis vs fungus:

Even after a thorough evaluation, it may be difficult for a physician to differentiate between nail fungus and psoriasis. Under such circumstances, one may opt for certain diagnostic tests for clarification. A microscopic examination of the specimen of the affected nail can be tested under microscope (KOH wet mount).

Another test is a culture where nail fungus comes positive.

If either of the tests gives confusing results the final step is to go for a nail biopsy which is an appropriate conclusive test.

The treatment of nail psoriasis and fungal infection is different. Hence, it becomes essential for the physician to perform necessary tests and get rid of the dilemma in order to treat the patient appropriately. You may end up thinking that it’s just a nail problem and go for a manicure. But think deep for an apparently simple nail problem may just be the tip of an iceberg! Nails are not just “Nails”, they add to your personality and beauty, have a look at them, take care, pamper them sometimes especially if you have any of a underlying disease as listed above!

If you are suffering from either nail psoriasis or fungal infection, do get in touch with us at LifeForce Homoeopathy. Dr Rajesh Shah’s research based homeopathy has helped many patients. To know more about how you can be helped, leave us your contact details below or give us a call at +91-22-66888888 or mail us at

– Dr Kanchan Gohil, Associate Doctor to Dr Rajesh Shah, Team LifeForce


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