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Psoriasis

A treatable skin condition

Psoriasis is a skin condition which causes thick, scaly rashes on the skin. A dysregulated, overactive immune system causes the normal skin replacement process to speed up, resulting in thickened inflamed skin. There are 5 types of psoriasis, classified based on their distinctive appearance. The most common form is plaque psoriasis, where the rash appears as pink, raised patches with some silvery scales. Some types of psoriasis, for example pustular psoriasis and erythrodermic psoriasis are rarer but can be life threatening. Guttate and inverse psoriasis are the other forms of psoriasis. For some patients, the inflammatory process underlying psoriasis can also affect the joints. This condition is called psoriatic arthritis and presents as painful, stiff joints.

Some patients with psoriasis will have a family member who is also affected with psoriasis. A flare-up of psoriasis can be triggered by stress, injury to the skin, infections and certain medications. Psoriasis has also been found to be associated with heart disease and diabetes mellitus.

For more information, please refer to www.psoriasis.org.sg , of the Psoriasis Association of Singapore.

Psoriasis can be mild, moderate or severe. Those patients with rashes covering less than 3% of their body is considered having mild disease, those with 3-10% covered is considered moderate. These categories are useful for deciding which treatments may be most appropriate for the patient. However, other deciding factors in selecting treatments such as the impact of psoriasis on the quality of life need to be taken into consideration too.

Mild cases of psoriasis are usually treated with topical creams such as calcipotriol and calcipotriol/betamethasone dipropionate. Phototherapy using narrow-band ultraviolet B (UVB) is a good adjunctive treatment. For more severe cases of psoriasis, systemic or oral medications may be necessary. These include methotrexate, cyclosporine and acitretin. Like many other drugs, the effectiveness of these medications must be balanced with the side effects that they may cause.

Biologic treatments or "biologics" are a new class of medication that have revolutionized psoriasis treatment. They are protein-based drugs derived from living cells in the laboratory and they have been in use to treat psoriasis in the last decade. This class of medication offers hope to psoriasis patients who have failed other treatments or have experienced side effects from their previous treatments. These medications are given as injections via the subcutaneous or intravenous route and help to reduce the inflammatory process that is driving the replication of skin cells and destruction of the joints.

In psoriasis, a protein in the immune system called tumour necrosis factor is known to be present at increased levels and this leads to inflammation. Tumour necrosis factor - alpha (TNF-α) inhibitors are a big group of biologics that binds to the excess TNF-α to decrease the inflammation process. Examples are Eternacept, Adalimumab and Infliximab. Another class of biologics works against interleukin 12/23. An overactive immune system can lead to high levels of interleukin-12 (IL-12) and IL-23, two naturally occurring proteins in the body that are involved in the development of psoriasis. Example of this class of biologics is Ustekinumab which specifically targets and blocks the action of IL-12 and IL-23. By preventing these two proteins from attaching to cells in your body, Ustekinumab slows down the overproduction of skin cells and helps reduce inflammation. The lastest biologic that is available in Singapore is Secukinumab. This is a human IgG1 monoclonal antibody that selectively binds to interleukin-17A (IL-17A) inhibiting its pro-inflammatory effects. IL-17A is involved in the developed of plaque psoriasis and is found in high concentration in psoriasis plaques.

Patients are assessed for their suitability for biologics based on their clinical history, concurrent medical issues and lifestyle needs.

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