Psoriasis is a chronic, inflammatory disease with a diverse array of clinical manifestations involving the skin, joints, and nails. Of these, nail psoriasis is a frequently overlooked, yet important complication of psoriasis which can cause significant physical and psychological distress to a patient. Psoriasis affecting the nail unit can pose both diagnostic and therapeutic challenges to physicians due to its clinical heterogeneity, the multitude of available treatment options, and the general lack of high-quality research on the subject. In order to aid the practicing clinician in appropriate diagnosis and treatment of nail psoriasis, this review provides an overview of the epidemiological, clinical, and pathophysiologic features of the disease, while also attempting to develop a rationale for effective medical management of the condition.