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.

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.

A dermatologist typically diagnoses psoriasis through an assessment of the patient’s medical and family history, as well as a physical examination of the skin, nails, and scalp to check for signs and symptoms. In some cases, they may also conduct a skin biopsy procedure, in which they extract a small skin sample from the affected area and examine it under a microscope. This helps to confirm the diagnosis and rule out other similar conditions.

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.

Although psoriasis is not curable, several treatment options are available to effectively manage the disease. Treatments for psoriasis can range from topical creams to phototherapy, tailored based on the severity of the condition and the type of psoriasis.

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.

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 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.