Psoriasis, a skin disease that presents itself as red, itchy scaly patches, is commonly found on the knees, elbows, trunk and scalp. Defined as a chronic, non-contagious, multisystem, inflammatory disorder, it affects approximately 125 million people worldwide, or 2% to 3% of the global population, according to the World Psoriasis Day consortium.
There is still no cure for psoriasis, and besides the physical appearance of the rash, the disease can also lead to other health implications in the long term. If left untreated, psoriasis may result in other complications, with significant health risks.
According to Dr Peter Ch’ng Wee Beng, consultant dermatologist at Gleneagles Hospital Kuala Lumpur, psoriasis is an immune-mediated disease, which can have a considerable effect on a patient’s quality of life, especially if it is underdiagnosed. “It's a disease that is caused by an overactive immune system and results in an inflammation that appears on the skin and starts spreading,” elaborates Dr Ch’ng.
“It presents itself as a rash, normally found on the extensors of the body like the elbows, knees and belly button. However, the inflammation is not just restricted to the skin. It’s also in your bloodstream and it can cause your blood vessels to become narrow,” he elaborates. “This of course can lead to potential heart disease and increased rates of what we call metabolic syndrome, leading to issues such as hypertension, diabetes, obesity, cholesterol and stroke.”
Triggers and causes
Dr Ch’ng says currently there is no data on how prevalent the disease is in Malaysia. However, the medical expert opines that based on estimates, it affects about 2% of the Malaysian population.
“There’s no data on when patients can get it, but we have seen the onset of psoriasis in patients in two age peaks –– in their 20s and in their 50s,” he notes. The dermatologist is quick to add, however, that he has also seen infants having psoriasis and also newly diagnosed patients who are in their 80s.
Genetics also plays a significant part, says Dr Ch’ng. “If one parent has it, there’s a 25% chance of your getting it. If both parents have psoriasis, then the percentage goes up to 60%. So, genetics does play a role; unfortunately there’s still no way to identity the kind of environment that will cause it.” He explains that modern medicine has identified what can trigger psoriasis and make it worse.
This includes trauma, such as an injury to the skin, which can cause psoriasis to occur on the site of the injury. Infections, such as a fever or sore throat, or endocrine disorders such as thyroid disease or menstrual and hormonal changes in women, can also cause psoriasis.
Drugs, such as hypertensive medication like beta blockers, may trigger psoriasis in patients. Psychological and mental and physical stress such as lack of sleep can also aggravate the disease.
Managing and coping with psoriasis
Although the disease presents itself in a physical form, it is also likely to impact patients psychologically “We know that it does affect the quality of life of patients, especially if it is left untreated or sub-optimally treated,” says Dr Ch’ng.
“There’s a confidence issue, self-consciousness, low self-esteem, discrimination and stigma, especially in the workplace and also in public places, which can affect occupation as well as social standing and lifestyle. This will lead to psychological trauma and depression. Also, if the infected area is at the genitals, this will affect partner and sexual relations as well.”
Psoriasis can also affect the joints and cause inflammation to the joints, increasing the risk of patients developing psoriatic arthritis. If left untreated, over the long term, this can lead to permanent deformity of the spine.
The key to managing the disease, stresses Dr Ch’ng, is early diagnosis. “If you see a small rash developing and you ignore it, it will start spreading to the surrounding area,” he explains. “When untreated, this can lead to your whole body having psoriasis.”
He adds that even though the rash may disappear, the affected area may have remnants of memory cells. He explains that these cells can live a long time, and all they need is a trigger to be woken up again. “The more memory cells you have, the more difficult it is to control your disease.”
Treatments and remedies
Thanks to medical advances, patients who suffer from psoriasis can not only seek remedies and treatments, but also ways to manage the disease as well as its symptoms. “When we prescribe treatments, we will first look at the severity of the disease. If the psoriasis affects less than 10% of the body, we administer topical treatments such as creams to help reduce the number of lesions or plaques that develops. However, even if it is less than 10% of the body surface area, if it involves important areas of the body such as the face, genitals, hands and feet, it is still considered severe psoriasis because it affects the patient’s quality of life,” says Dr Ch’ng.
For more severe cases, such as the psoriasis appearing on the face, palms and soles and genitals, or if it affects the joints, systemic treatments — oral treatment or injectables — are called for. However, the dermatologist is quick to caution that whatever systemic treatment is being administered, it should not be steroid-based.
“Even though steroid treatments do work, and the psoriasis can clear up, it can come back worse than before. Additionally, with continued use, patients can suffer the side effects of steroids such as obesity, thinner skin, osteoporosis, an increased risk of hypertension and diabetes.
Dr Ch’ng says in some cases, phototherapy — using light of a certain wavelength to treat the area — is administered. However, he adds that it is not practical as patients need to come to the clinic at least two or three times a week for treatment. Hence, he thinks biologics are the best way to combat the disease.
“Biologic drugs are composed of proteins and function as antibodies to target specific parts of the immune system that cause the psoriasis,” says Dr Ch’ng. “They are convenient and effective, and also available in pen-injectable form, allowing patients to administer the treatment themselves if needed.”
He points out that with medical advances today, patients who suffer from psoriasis can obtain complete skin clearance. “We have seen 50% of the patients who are on biologics have complete clearance of psoriasis, which is 100% skin clearance. As for 90% skin clearance, it is about 80% of the patients on biologics who see 90% improvement in the affected areas. Patients, however, still need to come back regularly to see if the biologics are still working. In most cases, though, it’s often months in between, which is a good sign.”
Besides medicine, Dr Ch’ng also advises patients to incorporate lifestyle habits and coping strategies to help them live with psoriasis. “This includes cutting down on smoking, as well as second-hand smoke, and reducing alcohol intake because this can lead to the flaring of the disease."
He also advises those who have psoriasis to consult an expert and not resort to buying supplements and traditional remedies as a form of treatment. “The internet today is rife with products and supplements to treat rashes; however, misdiagnosing psoriasis and administering the wrong treatment and medicine can cause extensive and permanent harm,” he says.
“What we do is control the psoriasis and avoid the triggers, and relapse will be less likely. Ultimately, proper diagnosis is key to allowing patients to better manage the disease so that they can continue to live normal lives.”
This article is brought to you by Novartis Malaysia.
To find out more about psoriasis, log on to https://mypsoriasis.my/
Armstrong AW. Psoriasis. JAMA Dermatology. 2017 Sep;153(9):956. DOI: 10.1001/jamadermatol.2017.2103. PMID: 28903148.