More than just a rash – What is Psoriasis?
Derived from the Greek word “psora”, which means “to itch” – psoriasis is a chronic, inflammatory skin condition that presents itself as thick, inflamed and flaky skin on its victims.
It is currently estimated to affect about 1-2% of Singaporeans, and is one of the top 10 most common skin conditions being treated here. Both men and women are equally affected by the condition – and even celebrities like Kim Kardashian are not spared from its undesirable effects.
While it is often confused and mistaken for Eczema, it is actually a much more painful condition that shows up in the extensor surfaces of the body – the most common areas being the arms, elbows, knees, limbs, ears, scalp and back. It is characterized by these symptoms:
- Dry, itchy and scaly rash (prone to bleeding)
- Raised, pinkish-red skin in well-defined patches
- Itching and burning sensation around affected patches
- Thick, silvery flakes of skin (known as plaques)
- Discoloured, thickened and pitted nails with yellow/brown spots
In the presence of “triggers” like extreme hot or cold temperatures, physical and emotional stress, infection, or during skin injury (e.g. scratches, cuts or sunburns) – psoriasis flare-ups arise. The disease will also develop into arthritis in 5-15% of patients – leading to the permanent damage and deformity of the joints.
Given that the disease is linked to several other health conditions, such as diabetes, heart disease and depression – it is pertinent that sufferers consult a doctor as soon as possible in order to start psoriasis treatment.
It begins inside – What causes Psoriasis?
There are currently 5 different types of psoriasis – the most common being chronic plaque psoriasis. Emerging as red elevated patches covered by “plaques”, lesions often pop up on the same places on both sides of the body in a somewhat symmetrical manner.
Other types include guttate psoriasis, pustular psoriasis, inverse psoriasis and erythrodermic psoriasis. Each comes with its own unique set of symptoms and characteristics that affects different body sites, and thus needs specialized treatment options.
There is currently no primary cause that has been identified to give rise to psoriasis, but studies propose that genetics play a huge role in its development, although other environmental factors may also aggravate symptoms.
Put simply, psoriasis is an autoimmune condition – meaning to say that the immune system is over-activated – causing the accelerated growth of cells that rise to the skin’s surface in 3 to 4 days as compared to the usual 28 days.
As a result, the excessive dead skin cells start to accumulate, forming thick white scales that pile up on the skin. It is often accompanied by inflammation due to the attack of healthy skin cells by the immune system – resulting in a defensive T-cell response that leads to red patches on the skin.
The Psoriasis Area and Severity Index (PASI) Classification
The PASI is the most widely adopted scale used to classify patients based on the extent and severity of symptoms on 4 body parts, i.e., the head, arms, trunk and legs.
Each body part is assigned a value, which is then added up for a final score. The higher the score, the more severe your condition.
The PASI is an effective measurement to reflect treatment outcomes, and is typically converted into a percentage response rate, e.g. PASI 50, PASI 75, PASI 100. Patients who have achieved PASI 100 is said to have attained a complete resolution of all disease in comparison to their baseline score.
Many doctors will also evaluate your condition based on the body surface area (BSA) of skin affected, denoted by a percentage.
Based on the BSA, the severity is broadly classified as follows:
- Mild psoriasis: < 3% of the body is affected.
- Moderate psoriasis: 3 – 10% of the body is affected.
- Severe psoriasis: > 10% of the body is affected.
Since diagnosis can be tricky, it is imperative that you obtain the right diagnosis as soon as you suspect you are showing signs of psoriasis.
Offering a conducive environment for assessment and treatment, our clinic has all the right tools needed for our doctors to perform a simple physical exam or biopsy with you – confirming any suspected diagnosis, and ruling out any other possible disorders and infections.
Who is most likely to get Psoriasis?
About 1 in 3 people who has someone in the family tree with psoriasis will also develop the condition. With most research pointing towards an underlying genetic component, symptoms sometimes may not show until an environmental factor activates it.
When it comes to age, psoriasis most commonly shows up anywhere between 15–35 years of age, although it is also common to develop the disease much later in life between 50–60 years of age.
Studies have also shown that psoriasis is far more common in people suffering from obesity. While the disease itself does not discriminate – the severity and symptoms can often be attributed to people living more unhealthy lifestyles.
There is currently no cure available for Psoriasis; however, it can be mostly controlled. Therapy comes largely in the form of systemic and topical treatments; with many more advanced options available such as phototherapy and biologic drugs.
The World Health Organisation has stated that much of the suffering caused by psoriasis can easily be avoided with correct and swift diagnosis, sufficient treatment, and proper care and support.
Due to the amount of physical discomfort that sufferers face, patients offer experience a lowered sense of well-being and quality of life. The key to psoriasis treatment is thus to control the symptoms, prevent later infections and ultimately – raise the patient’s quality of life.
Treatment option #1: Topical treatment
If your condition is mild, it may be enough to control and provide temporary relief simply by applying topical corticosteroids and emollients (moisturizers) that can help reduce the itch and scaling. Common treatment options include:
- Coal tar
- Salicylic acid
- Vitamin D-type drugs (e.g. calcipotriol or calcitriol)
Topical treatments often need to be taken long-term, and may take up to 6 weeks for any noticeable results. However, once treatment stops, psoriasis is likely to relapse.
Treatment option #2: Oral medications
For those who are facing more serious and extensive psoriasis, but are unable to undergo light therapy treatments – oral medications can still prove effective.
The most common tablets are methotrexate, cyclosporin and aciteretin. Methotrexate works by slowing down the accelerated growth of skin cells and restoring the skin in order to bring it back to its normal state.
Unfortunately, oral medications tend to lead to adverse side effects such as bone marrow, liver and kidney damage. In addition, long-term use of steroids has been shown to cause thinning of the skin, stretch marks and easy bruising. In fact, discontinued use of steroids can often lead to the rebound of the condition – sometimes even in a worsened state than before.
As such, it is highly recommended to undergo blood tests to check for blood cells count, as well as liver and kidney function before, during and after starting oral medications.
Treatment option #3: Ultraviolet Light Therapy (Phototherapy)
When topical or oral medications aren’t showing any results – light therapy, or phototherapy with ultraviolet A (UVA) or B (UVB) light may be carried out 2 to 3 times a week as treatment.
By using controlled wavelengths of laser light, phototherapy works to slow down skin cell turnover while reducing inflammation. Results are highly-effective; however, long-term exposure can increase the chances of skin burns and skin cancer.
The most effective light therapy available to date is Pulsed Dye Laser (PDL) – clinical studies have shown its effectiveness in treating various skin conditions including psoriasis, acne, rosacea and acne scars.
PDL works by destroying the tiny blood vessels that support the formation of psoriasis plaques, slowing down rapidly growing skin cells, suppressing an overly active immune system, and reducing itch and inflammation in order to allow the skin to heal.
In fact, there have been numerous studies done with sufficient evidence to show PDL as an effective and safe treatment method to treat localized plaque psoriasis.
At The Clifford Clinic, we have managed to devise a protocol that drastically improves the appearance and outlook of psoriasis. Due to the intricacies and sensitivities needed to work laser light, it is important to work with an experienced and competent doctor that knows how to choose the parameters of the treatment – especially when it involves multiple treatment areas, severities and a host of other factors.
What are biologic drugs?
If all the above-mentioned options prove unsuccessful, several biologic drugs may be prescribed as part of your treatment – offering an exciting new solution to psoriasis treatment that significantly lowers the risk of side effects.
Otherwise known as biologics – these are newer and ‘smarter’ types of medication that target particular molecules in the immune system that are responsible for psoriasis. Created from human or animal proteins, the most common drugs available in the market today are adalimumab and ustekinumab.
These newly-developed biological agents can be employed to treat moderate to severe cases with a BSA greater than 10% – meaning to say that patients suffering from extensive psoriasis will benefit most from biologic drugs.
In fact, Singapore is the first country in Asia to approve of ustekinumab for Eczema. Ustekinumab works by blocking 2 proteins – interluekin-17 and 23, and is a newer type of drug that has been shown to be equally effective in treating psoriasis.
Given its more highly-targeted action on the immune system that blocks the overactive immune cells in the body, biologics have so far provided amazing results – with patients showing great improvement in their symptoms by as much as 75-80%!
Most biologics are administered via injections into the subcutaneous layer of the skin, with a schedule varying from once a week, to once every 3 months. When performed by a competent and experienced doctor, biologics is considered to be a much safer treatment option in terms of side effects – clinical trials conducted have shown no serious major infections compared to those under a placebo.
However, it is important that a prior examination for contraindications such as Hepatitis B and C, HIV and tuberculosis (TB) is done before starting treatment. The biggest downside to biologic drugs to date is in its cost – easily racking up to over $1,000 a month.
No matter the treatment plan, be assured that our doctors will work closely with you to craft out specific treatment goals to gradually reduce your symptoms of psoriasis –bringing back your confidence slowly but surely.
A life-long battle
While psoriasis is a long-term condition that has a tendency to persist and recur throughout a patient’s life – when accompanied by consistent treatment, healthy lifestyle habits and regular health screenings – controlling the disease can result in better self-esteem levels and a boost in social confidence.
For now, a combination treatment is considered to be the most effective – our doctors at The Clifford Clinic will personalize a plan for you depending on several factors such as your age, sex, current condition and type of psoriasis in order to craft an effective psoriasis treatment plan that works.
If you think that you have any one of the above-mentioned symptoms, be sure to consult us as soon as you can – don’t wait for the red flags to turn into something far more serious!