Find out more about this skin disease and how you can manage it.

 

If you have noticed some flaky and thick patches on your skin that itch quite a bit, itching scalp and losing hair, you may be suffering from psoriasis. Psoriasis is a chronic inflammatory disease that affects the skin, scalp, nails and joints of the body.

Psoriasis, one of the top 10 skin diseases in Singapore, is estimated to affect one to two percent of the local population. (EDITOR’S NOTE: The prevalence of psoriasis likely increases with age, given the chronic nature of the disease and normal life-expectancy of psoriasis patients. Several studies have demonstrated that psoriasis is common in the elderly population.)

 

Symptoms & complications

Psoriasis on the skin appears as flaky, thick patches that can itch or become sore. These rashes can be disfiguring and embarrassing for sufferers if they appear on exposed parts of the body like the face, neck, arms or legs. Psoriasis on the scalp can itch, give rise to flaky dandruff, and can sometimes result in thinning hair.

Psoriasis on the nails can range from the appearance of small pits, discolouration or abnormal growth of the nails, separation of the nails from their beds, and even crumbling of the nails in severe cases.

Psoriasis can cause joint pain, swelling, stiffness, or even joint deformity if not treated early. This happens in up to one-third of people with psoriasis. Those with psoriasis have a higher chance of developing obesity, high blood pressure, high cholesterol, diabetes, heart disease, stroke and fatty liver.

Rare complications can sometimes occur where psoriasis affects so much skin that the whole body turns red, a condition known as erythroderma. Urgent care is often necessary to treat this condition.

 

7 common myths

1. It Is merely a rash.

This is not true. Psoriasis can affect other organs of the body such as the joints and tendons, and is known to increase the risk of diabetes and heart disease.

2. It Is contagious.

This is not true. Psoriasis is an inflammatory disorder and is not caused by an infectious agent.

3. It affects adults only.

Psoriasis can begin at any age.

4. It is caused by poor hygiene.

This is not true. Poor hygiene is not known to cause or trigger psoriasis.

5. If you have psoriasis, so will your child.

Although psoriasis is an inheritable condition, not everyone who has a family member with psoriasis will develop the disease. Exposure to risk factors in life, such as smoking, obesity, alcohol, certain medications, bacterial or viral infections, contributes to the development of psoriasis in people who already have the genetic inheritance. So, if you have psoriasis, your child may not have it, although your child may have a higher chance of developing psoriasis in life compared to those who may not have a family history of psoriasis.

6. It is curable.

Psoriasis cannot be cured but its symptoms can be controlled with medications and/or phototherapy.

7. Topical creams are the only treatment for psoriasis.

This is not true. Topical creams alone may be adequate to treat mild psoriasis. More extensive or severe symptoms often require other treatment methods such as phototherapy, oral immunosuppressive medications, or injection of biologics for better control of the disease.

 

Treatment options

Though psoriasis cannot be cured, it can be managed. It can come in varying severity, and can subside and can relapse. This makes it extremely frustrating for sufferers.

Anti-inflammatory creams containing coal tar, vitamin D or corticosteroids, as well as ultraviolet light therapy can improve the skin rash and itch of psoriasis. More severe symptoms are often treated with oral medications that suppress the immune system to quell the autoimmune attacks and inflammation in psoriasis and allow the body tissues a chance to recover. However, these oral medicines may have various side effects affecting different people, so regular blood tests are recommended to monitor for potential toxic effects on internal organs.

The newest and rather effective treatment for moderate to severe psoriasis are injectibles known as biologics, which are genetically engineered proteins that target specific parts of the immune system found to be active in psoriasis. They are able to treat almost all symptoms of psoriasis but are costly and can potentially increase one’s chance of getting a bacterial or viral infection or activate hidden diseases like tuberculosis. Typical treatments can vary from a few months to a year and beyond. Although biologics are effective, they are not a cure and relapses can still happen.

 

4 suggestions to improve quality of life

There are certain things you can do to help make your life easier:

1. Learn how to control your symptoms well by treating flare-ups early with medications on stand-by, avoiding triggers, practising good skin care and adopting a healthy lifestyle. Infections, skin injury, weather, emotional stress, smoking, alcohol, and certain medicines can trigger psoriasis. Regular use of moisturisers on your skin helps to reduce itch, irritation, and softens the plaques. Daily baths can help remove scales. Regular exercise, eating a healthy balanced diet, avoiding cigarettes and alcohol, can help improve symptoms, well being, and reduce your chances of developing chronic illnesses that are associated with psoriasis.

2. Learn how to manage stress. Stress can trigger psoriasis and psoriasis can in turn cause stress and even depression. Manage stress through relaxation techniques, meditation, and exercise. Consider attending stress management programs. Please talk to your doctor if you suspect you have succumbed to depression. Some of the symptoms of depression are lack of interest in things that you used to enjoy, inability to focus, loss of energy, inability to sleep, and feeling that you cannot get out of bed.

3. Get support. Join support groups such as the Psoriasis Association of Singapore to learn more about the disease, connect with others in similar situations, and share experiences on how to cope with psoriasis.

 

Dr Lim Chun Siong is a resident doctor at DTAP Clinic.

(** PHOTO CREDITS: psoriasisSPEAKS)