PSORIASIS

What is Psoriasis?

Psoriasis is an inflammatory skin​ disease characterised by an increased rate of skin cell turnover, resulting in thick scales appearing on the skin. The affected skin becomes dry and unsightly. Itching is often experienced in our hot and humid climate.

As part of our skin, nails also show changes like “pitting” of their surface in up to 50% of people with psoriasis. Joint pain and swelling are seen in 5-40% of those with more extensive psoriasis.

                 Psoriatic plaques on the back

How do you know if you have Psoriasis?

Psoriasis usually presents with red scaly patches on the scalp, body and limbs. The scaly patches on the scalp are usually thicker and more extensive than ordinary dandruff. Common body sites affected include the elbows, knees and back.

Why does Psoriasis happen?

Studies show that patients with psoriasis have a genetic predisposition to develop the disease, which is triggered off by environmental factors such as infection, or certain medications. As a result, there is an imbalance in the immune system which leads to the appearance of psoriasis.

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Psoriatic arthritis and nail psoriasis

                          Scalp psoriasis

What makes Psoriasis worse?

Physical and emotional stress are well known to aggravate psoriasis. Throat infections or flu may also aggravate the disease as well. Some drugs e.g. steroids and certain anti-hypertensives may provoke the appearance of psoriasis.

What’s the natural history of Psoriasis?

Psoriasis usually starts in the 20s but has been described at birth and in old age. Like diabetes and other chronic diseases, psoriasis has a delayed onset and seldom remit permanently. However, unlike other chronic illnesses, it rarely shortens life expectancy.

What treatment modalities are available for Psoriasis?

1. Topical Creams/Ointments/Scalp Solutions

Most people with psoriasis have mild disease and get considerable relief with topical applications. These include topical steroids, coal tar and nonsteroidal vitamin D3 derivatives e.g. calcipotriol and calcitriol. For the face, hairline and groin areas, mild steroid or calcitriol creams can be used.

2. Phototherapy

 
Psoriasis responds to ultraviolet (UV) light treatment. Ultraviolet light, either UVB or UVA have been found to be effective in clearing psoriasis if used in gradually increasing doses over a period of several months. UVA is usually given with psoralens to enhance the effect of phototherapy (PUVA).

Narrowband UVB Phototherapy Cabin

3. Oral Drugs

Your dermatologist may prescribe oral medications when psoriasis does not respond to topicals and phototherapy. Examples of such drugs include methotrexate, cyclosporin, acitretin and hydroxyurea. Unfortunately, these drugs can sometimes cause severe side effects. Patients who are taking such drugs will require regular blood tests to detect side effects e.g. liver damage, bone marrow damage, etc.

4. Biologics

These are drugs which help to control extensive disease when other treatments have failed. Biologics have to be administered via injection just under the skin or into a vein. They work by balancing the immune system in the skin. As these are powerful drugs, side effects can occur and patients need regular blood test monitoring.

How we can handle Psoriasis?

Do’s

• Do use treatments regularly as directed.

• Do keep skin well moisturised as this will help reduce itching and scaling.

• Do have healthy lifestyle habits, eat in moderation, exercise regularly and manage your stress levels.

• Do regular health screening as obesity, diabetes, high blood pressure and cholesterol problems are more common in psoriasis.

• Do remember that the sun may help psoriasis but be careful not to get sunburnt.

• Do monitor for any joint pain or swelling as a proportion of patients also have psoriasis involving the joints (psoriatic arthritis).

Don’t’s

·  Don’t scratch the plaques as this may damage the skin and actually worsen psoriasis.

·  Don’t give up treatments too soon as it may take a few weeks for some of them to work.

·  Don’t allow yourself to have too many thoughts of self-pity or sadness. Don’t distance yourself from your loved ones. Learn to accept it as part and parcel of life.

Is Psoriasis contagious?

No

Will I pass Psoriasis to my children?

Not necessarily so. Psoriasis is a hereditary disorder but only about 10% of people with psoriasis have a family member affected by psoriasis. The causation of psoriasis is a multi-factorial and inherited genes do not always express disease without the appropriate environmental triggers.

 Is Psoriasis a rare skin disease?

No, psoriasis is not an uncommon skin disease. It is estimated that 1-2% of the population have psoriasis.

Are there any foods to avoid, or supplements to help my Psoriasis?

No, but it is wise to consume a nutritious, well balanced diet containing more green vegetables and less meats. Excessive alcohol consumption is best avoided because of its association with malnutrition and liver disease.

Is there a quick cure for Psoriasis?

No, but your doctor should be able to help you control your psoriasis. Oral or injected steroid treatment is best avoided because although it helps to clear psoriasis fast, it may result in a quick and severe rebound of psoriasis. But remember, psoriasis can be controlled with appropriate treatment.

How is psoriasis related to metabolic disorders?

In psoriasis, there is chronic inflammation of the skin and an imbalance in the skin’s immune system. This can also contribute to heart disease, development of hypertension and diabetes.

1. Consult your doctor for advice on screening for metabolic disorders.

• Check body mass index/waist circumference.
• Blood pressure measurement.
• Blood tests for cholesterol and glucose levels (Fasting of 8 hours is required for cholesterol and glucose tests).

2. Stop smoking.

• ​Smoking cessation counselling is available in NSC. Please ask your doctor or pharmacist for more information.

3. Avoid alcohol abuse.

4. Mai​​ntain a healthy weight, diet and exercise regularly.

5. Ensure metabolic disorders are well-controlled.​

DEDICATED TO EXCELLENCE IN DERMATOLOGY
By National Skin Centre (Singapore)
Copyright (C) 1995 - National Skin Centre (Singapore)