Psoriasis

What is Psoriasis?

Psoriasis is a chronic inflammatory skin condition. It is a common skin disease that can affect 1 in 50 people. Men and women have equal risk of developing psoriasis. Due to overly hastened turnover of the skin cells, the outermost skin layer is not able to shed-off in time. This leads to appearance of thick, red to pink scaly and flaky bumps on the skin.

What causes Psoriasis?

The exact cause of psoriasis remains unknown. It is believed environmental, genetic factor, and immune system have interplayed roles in psoriasis. About one third of psoriasis patients have family members with the same skin condition.

What are the symptoms and presentations of Psoriasis?

  • A red, palpable/elevated, hyperkeratotic (thickened) area of skin with silver-white scales on the surface
  • Affects both sides of the body
  • Tends to occur over the scalp, extensors of the elbow or knees, back of the ear, genital region and the body
  • Unusual thickening or irregular surface of the nails
  • Uncommonly, 30% of patients with Psoriasis developed inflammation of the joints (psoriatic arthritis).

What are the different types of Psoriasis?

There are 5 types of psoriasis.

  • Chronic plaque psoriasis: Most common type. Appears as persistent symmetrical red scaly patches over the body, arms, legs
  • Guttate psoriasis: Appears as small tear-dropped size bumps
  • Inverse psoriasis: Appears as red patches occurring underneath the breast folds, genital areas
  • Pustular psoriasis: Appears as widespread bumps with pustules
  • Erythrodermic psoriasis: Appears as widespread lobster red skin. This is a severe rare type that requires hospitalization as there are risks of fluid loss, dehydration, electrolyte imbalance, and heart failure

Who is at risk of Psoriasis in Singapore?

The average age of onset of Psoriasis is in mid 20s, with a second peak of incidence in the mid 50s-60s age group. Both men and women are at equal risk of developing psoriasis. Family history of Psoriasis is a known risk factor for a person to develop Psoriasis.

Is Psoriasis painful?

When Psoriasis condition is not controlled, one may experience skin discomfort such as itch, tightness over the rash, pain or experience joint pain. You are advised to seek medical attention early if you have Psoriatic rashes as there are effective treatment to manage Psoriasis.

How is Psoriasis diagnosed?

It is a clinical diagnosis based on history and physical examination of the skin rash. In situation where the diagnosis is uncertain, your doctor may offer you skin biopsy procedure to obtain skin sample to aid the diagnosis of the skin condition.

Can I get cured from Psoriasis?

Unfortunately, Psoriasis tends to run a persistent course. Nonetheless, there are effective clinical treatment options available. Speak to your doctor on treatment options.

What are the treatment options for Psoriasis?

The goal of treatment is to control the condition, reduce flaring, and maintain a decent quality of life. As 75% of Psoriasis cases are mild-moderate severity in presentation, topical treatment such as coal tar, steroid cream, vitamin D3 derivatives (calcipotriol) are beneficial in managing the condition.

In more severe cases, your doctor may advise second line treatment such as phototherapy, oral immunosuppressants or biologics. You are advised to discuss with your doctors on your condition as treatment should be tailored individually.

FAQS

You are advised to avoid triggers that can worsen Psoriasis. As new Psoriasis rashes can appear over site of skin trauma or injury, you are advised to avoid scratching, lasers, tattooing or unnecessary surgical procedure on the skin.

Maintaining overall good immune system is important as Psoriasis flare up may occur following infection. Excessive alcohol consumption and smoking should be avoided to prevent worsening of Psoriasis.

Your doctor may also screen through your medication lists as blood pressure or mood stabilizer medication may trigger Psoriasis.

People with Psoriasis are associated with higher risk of cardiovascular disease, stroke, elevated cholesterols, insulin resistance, impaired glucose tolerance, diabetes, hypertension and kidney disease.

There is also clinical susceptibility to autoimmune conditions such as thyroid disease, inflammatory bowel disease in patients with Psoriasis. You are advised to discuss with your doctor on healthy lifestyle intervention and early cardiovascular screening in reducing the health risks.

No, contrary to other inflammatory skin conditions such as atopic dermatitis, contact dermiatits, Psoriasis is not an allergic condition. There is currently no clinically evident allergic precipitating factors in Psoriasis.

Psoriasis is not a contagious disease, and rest be assured that it will not be transmitted through contact, touching, sharing of meals or sexual activities.

There are strong clinical evidence of excessive alcohol intake contributes to the severity of psoriasis. Also, people who drink excessively has a poorer response to Psoriasis treatment. Occasionally one may have both the habit of smoking and alcohol.

The combination lifestyle of cigarette and alcohol worsens the treatment outcome of Psoriasis and further increases the risk of cardiovascular disease in these patients. You are advised to discuss with doctor on ways to moderate alcohol consumption and consider smoking cessation to ensure a good control of Psoriasis.

Diet in Psoriasis is one of the common concerns of patients. Although diet is commonly mentioned as a ‘causative factor’ in Psoriasis —particularly by social media— there is currently no strong clinical evidence that Psoriasis can be due to dietary deficiency or ‘food allergy’. You are advised to have a balanced and healthy diet. Speak to your doctor if you have concerns regarding your diet and Psoriasis flare ups.

This is a valid concern that tends to be compounded by anxiety that the Psoriatic rash over the genital region may be due to sexually- transmitted disease contagious to the partner. Furthermore, patients may be concerned on whether the treatment used in Psoriatic rash can cause irritation to their partner’s skin upon contact/touching.

Rest assured, Psoriasis is not an infection. The medications used on the Psoriasis rash do not cause discomfort or affect your partner’s skin. You can continue your sexual activities as per normal days.

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