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In the case when there are no psoriasis lesions on the skin of a person, and only the nails are damaged with psoriasis, it is sometimes difficult for a doctor to make a correct diagnosis. Nail psoriasis often resembles a fungal damage of the nails.

Nail psoriasis usually appears in people that already have psoriasis on their skin. In rare cases nail psoriasis may appear before the skin manifestations. And in the rarest cases psoriasis will only appear on the nails of a person and will never appear anywhere else.