What is psoriasis?
Psoriasis is a common inflammatory skin condition that affects about 1% (1 in 100) of the population. It results from rapid multiplication of skin cells leading to thickening of the skin and scaling. It is estimated that there are about 80 million people with psoriasis throughout the world. In Singapore, it is estimated that at least 40,000 persons are affected with psoriasis.
What does psoriasis look like?
Psoriasis appears as red patches of skin covered with loose silvery scales that flake off constantly. It can occur on any part of the body although the knees, elbows, back and scalp are common sites of involvement.Commonly, it begins as persistent dandruff in the scalp before spreading elsewhere. These may often be accompanying irritation or itch but the severity of this may vary considerably from person to person. Sometimes if the patches are thick and dry they crack and become sore.
Chronic plaque psoriasis is the most common form of psoriasis. This commonly affects the scalp, knees and elbows and umbilicus, although any part of the body can be affected.Guttate psoriasis presents as small plaques of psoriasis scattered on the trunk and limbs. This form of psoriasis is often aggravated by streptococcal throat infections. Other forms of psoriasis include pustular psoriasis, palmoplantoar, inverse or flexural psoriasis.
In addition to the skin, psoriasis can sometimes also affect the nails and joints. Psoriatic arthritis or painful swelling of the joints commonly affects the small joints of fingers, the knees and ankles. In some persons, the arthritis may develop before the appearance of skin changes or vice versa. Anti-inflammatory drugs, rest and physiotherapy are used in the treatment of psoriatic arthritis. Early and effective treatment of arthritis can prevent deformity of the joints.
What causes psoriasis?
Psoriasis is neither infectious nor contagious. It cannot be passed on to other persons. It is not caused by poor standards of hygiene.The cause of psoriasis is believed to be multi-factorial—a combination of genetic and environmental factors triggers the abnormally rapid growth of skin cells.
Hereditary or genetic factors play a part in the development of psoriasis. In some patients, family members may also be affected by psoriasis. However, the actual pattern of inheritance has still to be clearly established.
Environmental factors like physical or chemical injury to the skin, throat infections, reaction to certain drugs, hormonal changes, climate factors and more commonly, physical, mental and emotional stress can precipitate the onset and contribute to the perpetuation of psoriasis.
Ingestion or abuse of alcohol is known to make psoriasis worse or difficult to clear with treatment. Smoking makes certain type of psoriasis resistant to treatment.
Medical science has pointed out that the environmental factors contribute to stimulation or activation of certain cells in the immune system (psoriasis T-lymphocyte) which are drawn to the skin. These immune cells release certain chemicals (cytokines) which in turn activate the epidermal skin cells to multiply at a faster rate.
Who gets psoriasis?
Psoriasis affects men and women in equal numbers and may appear for the first time at any age. It does however start more frequently between the ages of 15 and 45 particularly during puberty and menopause. Psoriasis may appear in children. Psoriasis affects all major races and is found throughout the world. Persons of all socio-economic classes and educational levels may be affected. There is a family history in a quarter to a third of persons with psoriasis.
Is psoriasis contagious?
Psoriasis is neither infectious nor contagious. It cannot be passed on to other persons. It is not caused by poor standards of hygiene.
What is the impact of psoriasis?
Psoriasis is known to be a waxing and waning disease. There may be considerable variations in a severity from person to person and in any one person from time to time. The extent of skin involvement varies from a few patches in the majority of cases, to widespread and serious eruption. A type of psoriasis, erythrodermic psoriasis is generalised, affecting the entire skin and requires intensive medical and nursing care.Psoriasis has a tendency to persist and recur. It can be an economic and social burden. Widespread ignorance of the public and misconceptions about the disease result in social avoidance and embarrassment in people with psoriasis. This may lead to social withdrawal and feelings of isolation, depression and defensive shyness. Sometimes the psychological suffering can be more severe than the physical suffering.
Can psoriasis be cleared?
Sometimes, psoriasis patients may lose the condition naturally for long periods of time and completely on occasions. Careful planning and good compliance with treatment may leave the patient with minimal or no skin lesions for several years after completion of treatment. Long term treatment is usually necessary and multiple visits to the clinic may be required. Psoriasis by nature responds slowly to treatment. Severe psoriasis may require hospitalization.
What is abnormal about psoriasis skin?
Psoriasis is in simple terms, only a vast acceleration of the usual replacement process of the skin. The epidermis is the uppermost portion of the skin. The epidermis is made up of layers of cells. The epidermis cells gradually change and move to the surface where they are continuously shed and replaced. Normally, a skin cell matures in twenty to thirty days during its passage to the surface where a constant invisible shedding of dead cells and scales takes place.Psoriatic cells mature in three to eight days and in such chaotic manner that even live cells reach the surface and accumulate with the dead ones into visible layers.
There is no link between psoriasis and cancer.
Is there a cure for psoriasis?
Although medical science has made great advances in the understanding of psoriasis, permanent cures are not yet possible. However, in many, the psoriasis skin can be completely cleared and returned to normal with effective treatment. In some persons where complete clearance is not possible, treatment can improve or control the extent of disease.Relapses of psoriasis are problems for which there are no easy answers. Avoidance of aggravating factors may prevent or reduce relapses.
Treatment is aimed at slowing down the rapid cell division of the skin. By restoring the skin to its normal condition, the physical discomforts and the socio-economic disadvantages of psoriasis are reduced and this will lead to an improvement in the quality of life for those with psoriasis.
What treatments are available for psoriasis?
A variety of treatments are available. The external forms of treatment include tar shampoo, tar creams, calcipotriol (Vitamin D3) ointment, dithranol creams and ointment and steroid cream. Internal therapy in the forms of tablets includes methotrexate, cyclosporin andretinoids. Ultraviolet light therapy in the form of UVB or PUVA (a combination of oral psoralen and ultraviolet light A) are effective physical forms of treatment.Recent scientific advances in psoriasis research has resulted in the development of biologic treatment. Unlike other medicines which are made by combining chemicals, biologics are created from human or animal proteins. Biologics are given as injections and treat psoriasis by targeting and blocking overactive immune cells in the body.
Sometimes a combination of treatments may be offered. The dermatologist must plan with the patient the most suitable treatment for that individual. The choice is based on the age, sex, general health, extent of disease, the type of psoriasis and the ability to comply with the treatment program.
Is there any hope that a cure will be found?
Certainly, but this is unlikely in the immediate future. Medical research in treatment of psoriasis is being carried out in many parts of the world. Over the last decade great strides have been achieved in the treatment of psoriasis. Intensive research is necessary not only for us but also for our future generations.
What are some useful tips on managing psoriasis?
- If you suspect you have psoriasis, see your physician or dermatologist to confirm the diagnosis as there are many treatments available to manage the condition.
- A healthy lifestyle is important. Reducing stress in your life and living and eating healthily can help the psoriasis and also reduces your risk of developing heart disease.
- If you are in need of psychosocial support, do let your attending doctor or dermatologist know as they are many avenues available such as support groups that can help you cope with the disease.