Dealing with severe nail psoriasis can be frustrating, but effective treatments are available. Because thick nails are hard to penetrate with topical creams, systemic medications that work from within are usually the most effective choice for severe cases. Your dermatologist may recommend oral medications like methotrexate or apremilast, or advanced biologic therapies such as adalimumab or secukinumab. Corticosteroid injections near the nail bed can also help. I highly recommend scheduling an appointment with a dermatologist. They can safely evaluate your health and tailor a treatment plan to help your nails regrow healthy and clear over time.