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