What is Psoriasis?

Psoriasis is a chronic inflammatory skin disorder which causes dry, flaky and itchy skin. The rashes are usually localised on the extensor surfaces (the skin covering the outer surfaces of joints) like the elbows, knees and knuckles, but they can show up around the ears, scalp and back as well.

Causes and risk factors

Afflicting about 1-2% of all Singaporeans, psoriasis is an autoimmune skin condition caused by excessive activity of the immune system to external stimuli. The overactive immune system induces accelerated growth of skin cells which rises up to the surface in 3 to 4 days, as compared to the typical 28 days. The immune system also attacks healthy skin cells, causing affected regions of the skin to become inflamed which results in red, itchy and flaky skin rashes.

The exact cause of psoriasis is currently unknown. However, medical researchers have identified certain factors and correlations that may increase the chances of one developing psoriasis.

  • Genetics: About 1 in 3 people who have a family history of psoriasis is likely to develop the condition at some point in their life. The condition may lie dormant until it is triggered by an environmental stimulus.
  • Obesity and unhealthy lifestyles: Although there is no direct evidence pointing to a relationship between obesity and psoriasis, the condition is certainly more common amongst those who are obese. This may be attributed to having an unhealthy lifestyle, which is associated with both obesity and increased exposure to psoriasis triggers.

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Signs and Symptoms

Often mistaken for severe eczema because of the similar symptoms, psoriasis is actually a much more troubling condition described by the following symptoms:

  • Dry, itchy and scaly skin rashes which are prone to flaking and bleeding
  • Well-defined, raised patches of reddish-pink skin
  • Burning, mildly painful sensation on the affected skin
  • Thick, silvery flakes of skin (known as plaques)

These signs and symptoms may seemingly recover by themselves sometimes when left alone. However, the symptoms will easily relapse with certain triggers. Some of these triggers include, but are not limited to:

  • Excessively warm or cold environment
  • Physical and psychological stress
  • Other skin diseases/infections/irritation
  • Skin injury from cuts/abrasions or burns (including sunburns)

In many patients, psoriasis can affect the fingernails and toenails too, in a condition known as nail psoriasis. In these cases, the nails can take on the following symptoms:

  • White, yellow and brown discolouration on the nails
  • Pits and dents on the surface of the nails
  • Fragile and crumbling nail tissue
  • Build-up of yellowish-white debris of nail and dead skin tissue under the nails. In severe cases, these can push the nail away from the nail bed, causing pain and discomfort
  • Blood and blood clots under the nail with no recent history of injury
  • If left untreated, ingrown nails can occur from irregular nail growth

Symptoms of nail psoriasis take longer to surface as compared to plaque psoriasis as nails grow much slower than the skin. In many cases, the nail symptoms are only observed weeks, or even months, after the skin symptoms show.

Treatment

When left untreated, psoriasis can be very persistent, recurring throughout a patient’s life and affecting their quality of life and social confidence. However, psoriasis can be easily controlled with proper treatment and medication.

The Clifford Clinic offers the following treatment procedures for psoriasis:

  • Pulsed-Dye Laser

Pulsed-Dye Laser treatment is one of the most effective treatments for psoriasis and other vascular skin conditions like rosacea on the market with minimal to no side effects. The Clifford Clinic is the only clinic/centre in Singapore to offer Pulsed-Dye Laser for the treatment of Psoriasis. We are also the only clinic in Singapore to use V Beam Prima to treat Psoriasis.

The treatment works by delivering controlled pulses of intense laser energy to targeted treatment areas to slow down and stop excessive skin cell growth. The laser treatment works via 3 main mechanisms:

  • Partial suppression of overactive immune system by reducing the activity of key proteins involved in inflammatory reactions like E-selectin and IL-23.
  • Directly collapsing tiny blood vessels supplying the psoriasis tissues, interrupting their blood supply.
  • Decreasing the expression of key proteins involved in the formation of new vascular tissue (blood vessels) like VEGFR2 and VEGFR3.

By disrupting blood supply to the psoriasis plaque tissues and suppressing inflammation reactions inducing the production of new skin cells, Pulsed-Dye laser can effectively slow or stop psoriasis plaque formation. Eventually, the symptoms will cease after several treatment sessions, alleviating both plaque psoriasis and nail psoriasis.

  • Topical medication

Topical medication may be prescribed to patients with milder conditions to directly relieve the symptoms of psoriasis. These may be corticosteroids or emollients (moisturisers) which will ease the itching and scaling of the skin. Examples include:

  • Dithranol
  • Salicylic acid
  • Vitamin D-type drugs like calcipotriol

However, topical medication is seldom used alone as the relief is only temporary. Symptoms are very likely to return when medication is stopped. In most cases, topical medication is usually a supplement together with other more effective treatments like the Pulsed-Dye Laser.

  • Oral medication

Prescribed oral medication is also effective in treating mild to moderate psoriasis. Most of them work by directly slowing down the accelerated growth of skin cells, restoring the skin to a normal state. Amongst others, the most common prescribed oral medication include methotrexate, cyclosporin and aciteretin.

However, like topical medication, psoriasis may relapse if the oral medication ceases. Even though there are cases where the condition is completed cured after oral medication, such cases are rare. Similarly, oral medication is usually prescribed together with other treatments.

In addition, steroidal oral medication has some risk of complications such as bone marrow, liver and kidney damage. Also, some of these medications may thin out the skin after prolonged use, making it prone to bruising.  Hence, our doctors strongly recommend those who are on, or intend to consume these oral medications to go for regular blood tests, as well as health checks on liver and kidney functions.

At The Clifford Clinic, we have devised a treatment protocol using a combination of the 3 treatment options listed. The protocol focuses on the most effective Pulsed-Dye Laser treatment, while prescribing topical and oral medication as required, depending on the patient’s condition. Under our care, plaque psoriasis can typically subside in several weeks following regular treatment. Nail psoriasis treatment, on the other hand, may take longer to show results because of the slower growth rate of the nails.

Each patient will have a customised treatment regimen based on the severity of their condition and other considerations. Our doctors are highly skilled with more than 10 years of experience in managing patients with psoriasis and will do their best to offer high quality professional advice and treatment for you.