Psoriasis
Dr Cheong Wai Kwong
Senior Consultant Dermatologist
- Bachelor of Medicine, Bachelor of Surgery (Singapore)
- Member of the Royal Colleges of Physicians (United Kingdom)
- Fellow of the Royal College of Physicians (Edinburgh)
- Diploma in Venereology (London)
- Fellow of the Academy of Medicine Singapore (Dermatology)
How Psoriasis Affects the Skin
Psoriasis commonly develops between the ages of 15 and 45 and affects an estimated 1–2% of Singapore’s population. It is not contagious but can be persistent, often requiring ongoing management guided by a dermatologist.
What Causes Psoriasis?
Psoriasis is an immune-mediated inflammatory skin disorder. The underlying immune dysfunction is thought to result from the complex interplay between genetic and environmental factors.
Some patients with psoriasis may 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.
Common Symptoms of Psoriasis
The most common indication is the presence of raised, red patches (plaques) on the skin, covered with silvery or white scales, primarily appearing on the elbows, knees, scalp, lower back, feet, nails, and genital regions. Other signs and symptoms include:
- Skin that feels burning or itchy
- Dry, cracked skin that bleeds
- Skin pain or soreness
- Pitted (dented) or discoloured nails
The severity of symptoms can range from mild to severe, with some individuals experiencing occasional flare-ups while others have persistent symptoms.
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.
What Are the Types of Psoriasis?
There are several types of psoriasis, classified based on their distinctive appearance and symptoms.
Chronic Plaque Psoriasis
– The most common type of psoriasis, presenting as pink, raised, scaly patches on the scalp, knees, elbows, and torso. Patches may appear symmetrically on both sides of the body and cause pain, cracking, or bleeding.Pustular Psoriasis
– A rare type of psoriasis, characterised by non-infectious pus-filled blisters (pustules) surrounded by red, inflamed skin. This type of psoriasis typically appears on the hands and feet and can be triggered by certain medications, infections, or stress.Erythrodermic Psoriasis
– Rare but severe and can be life-threatening, this form of psoriasis results in widespread skin redness and shedding, often with intense pain, difficulty maintaining proper body temperature, and an increased heart rate. Triggers include bad sunburns or certain medications.Guttate Psoriasis
– This type of psoriasis manifests as small, teardrop-shaped skin patches, typically appearing on the torso or limbs. It is commonly observed in children and young adults and is often triggered by bacterial or viral infections, such as Streptococcal throat infection.Nail Psoriasis
– This condition causes various changes in the nails, including pitting, discolouration, thickening, or separation from the nail bed.
Psoriasis can be mild, moderate or severe. Those patients with rashes covering less than 3% of their body are considered to have mild disease, those with 3–10% covered are 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.
How Is Psoriasis Diagnosed?
How Is Psoriasis Treated?
Although psoriasis is not curable, several treatment options are available to effectively manage the disease. At Specialist Skin Clinic, we offer treatments for psoriasis that range from topical creams to phototherapy, with each plan tailored to the severity of the condition and the specific type of psoriasis.
Topical Therapy
For most individuals with mild psoriasis in Singapore, topical treatment is typically the first-line option. These medications are applied directly to the skin to reduce inflammation, slow excessive cell growth and relieve itching.
- Vitamin D Analogues – Calcipotriol helps normalise skin cell turnover and improve plaque appearance. Combination formulations with betamethasone dipropionate provide both anti-inflammatory and cell-regulating effects, offering faster relief during flare-ups and followed by milder maintenance therapy.
- Corticosteroids and Other Agents – Topical corticosteroids used alone are only meant for sensitive parts of the body such as the face, underarms and groin areas. Alternatives like calcineurin inhibitors (tacrolimus, pimecrolimus) may also be used in sensitive areas or where long-term steroid use is less suitable.
Phototherapy
If topical treatments do not provide adequate control, phototherapy may be recommended as an adjunct. This involves exposing the skin to controlled doses of narrowband ultraviolet B (UVB) light to slow excessive cell growth and reduce inflammation. Sessions are usually conducted two to three times a week under specialist supervision.
Oral or Injected Medications
For individuals with moderate to severe psoriasis, these treatments can help by calming the overactive immune response that drives inflammation in the skin. These medications can either be taken orally or by injection.
- Methotrexate – A longstanding treatment for moderate to severe psoriasis, methotrexate slows excessive skin cell growth and suppresses immune activity. It can also relieve joint symptoms in psoriatic arthritis and is typically taken once weekly by mouth or injection.
- Cyclosporine – Cyclosporine suppresses immune cells that trigger psoriasis flares, providing rapid relief during severe outbreaks. However, due to potential effects on blood pressure and kidney function, it is usually prescribed for short-term or intermittent use.
- Acitretin – An oral retinoid derived from vitamin A, acitretin normalises skin cell turnover and reduces thickened plaques. It is particularly helpful for pustular or erythrodermic psoriasis, but is strictly contraindicated in pregnancy and for up to three years before conception due to the high risk of birth defects.
- Apremilast – Apremilast is a newer non-biologic oral medication that inhibits the enzyme PDE4 to reduce inflammation. It is generally well tolerated and convenient, as it does not require routine blood monitoring. Common side effects include mild gastrointestinal upset, weight loss and occasional mood changes.
Biologic Drugs (Injectable Medication)
Biologic treatments or “biologics” are a new class of medication that has revolutionised psoriasis treatment. They are protein-based drugs derived from living cells in the laboratory and 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 the 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 bind to the excess TNF-α to decrease the inflammation process. Examples are Etanercept, Adalimumab and Infliximab. Another class of biologics works against interleukin 12/23 which are associated with psoriatic inflammation. An example of this class of biologics is Ustekinumab which specifically targets and blocks the action of IL-12 and IL-23.
The latest biologics that are available in Singapore are Secukinumab (Cosentyx®) and Ixekizumab (Taltz®). Guselkumab (Tremfya®) and Risankizumab (Skyrizi®). Secukinumab is a human monoclonal antibody that selectively binds to interleukin-17A (IL-17A). IL-17A is involved in the development of psoriasis. Ixekizumab is a humanised monoclonal antibody against IL-17A. Guselkumab is a human monoclonal antibody that binds to IL-23 with high specificity and affinity. Risankizumab is a humanised antibody against IL-23. All these biologics interrupt the inflammatory cycle of psoriasis leading to improvement of the condition.
These injections are all available in the clinic. Patients are assessed for their suitability for biologics based on their clinical history, concurrent medical issues, and lifestyle needs.
Tips on Managing Your Psoriasis
In addition to medical treatments, lifestyle changes and self-care measures can help improve symptoms and prevent psoriasis flare-ups. The following are some tips for managing psoriasis:
Maintain Skin Moisture
– Moisturise regularly to ensure skin hydration and reduce discomfort, scaling, and inflammation.Avoid Scratching
– Resist the urge to scratch the affected areas to prevent irritation, infection, or new skin lesions from forming.Steer Clear of Fragrances
– Opt for fragrance-free or hypoallergenic skincare products to minimise irritation.Adopt Healthy Lifestyle Practices
– Maintain an optimal weight, consume a balanced diet, and engage in physical activity.Reduce Stress
– Patients can manage stress levels by engaging in physical exercises and practising relaxation techniques such as deep breathing or meditation.Refrain from Drinking Alcohol and Smoking
– Limit alcohol consumption and quit smoking to avoid aggravating psoriasis symptoms and increasing the risk of skin damage.
Frequently Asked Questions About Psoriasis
Is psoriasis contagious?
No, psoriasis is not contagious. The condition develops because of an internal immune response that affects how skin cells grow, not because of infection. You can interact normally with others without worrying about transmission.
Is there a cure for psoriasis?
Psoriasis is not curable, but many effective treatments can control symptoms and reduce flare ups. These treatments calm the overactive immune response and slow rapid skin cell growth. With the right plan guided by a specialist, most patients can achieve good long term control and improved skin comfort.
Are there any complications associated with psoriasis?
Psoriasis can increase your risk of developing other health problems, such as psoriatic arthritis, heart disease, and diabetes. This is because the inflammation involved affects the body beyond the skin. Regular medical review helps detect these issues early and supports long term personalised care to keep symptoms stable and overall health protected.
Is psoriasis hereditary?
Psoriasis can run in families, so having a parent or sibling with the condition may increase your risk. Even so, not everyone with a family history will develop it. Other factors such as the immune system and the environment also play a role. A doctor can help explain your individual risk in clearer terms.
Our Psoriasis Specialist
Dr Cheong Wai Kwong
Senior Consultant Dermatologist
- Bachelor of Medicine, Bachelor of Surgery (Singapore)
- Member of the Royal Colleges of Physicians (United Kingdom)
- Fellow of the Royal College of Physicians (Edinburgh)
- Diploma in Venereology (London)
- Fellow of the Academy of Medicine Singapore (Dermatology)
Dr Cheong served as President of the Dermatological Society of Singapore from 2000 to 2005 and has led regional consensus initiatives on immune-based inflammatory skin disorders. He has also conducted workshops and shared clinical experience with fellow dermatologists on the use of biologics for psoriasis and continues to be actively involved in speaking engagements both locally and regionally His practice focuses on individualised treatment strategies, close monitoring and evidence-based approaches to achieve optimal skin health.
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