What is psoriasis?
Psoriasis is a common
life-long skin disease that also affects the nails and joints. The skin lesions
appear red and covered by thick white scales due to a rapid life cycle of skin
cells. It is non-contagious, not related to food and is not caused by allergy.
The course of disease is characterized by period of improvement or remission
alternating with period of flares.
It is estimated that
psoriasis affects 1-3% of the population worldwide. In Malaysia, a few tertiary
centres reported 2.1 to 9.5% of skin clinic attendees are due to psoriasis. Men and women are affected equally. Psoriasis can begin at any age with
most reported between 12 and 36 years but it is uncommon under the age of 10
years.
What causes psoriasis?
The exact cause of
psoriasis remains unknown. Inheritance of gene that causes psoriasis is
believed to play a key role. Approximately 30% of affected individuals also
have family members with psoriasis. Various factors are known to trigger or
aggravate the disease such as infections, trauma, stress, alcohol, smoking and
certain drugs. In the past, psoriasis was thought to be due to abnormality in
the skin cells. However, advances in medical sciences currently
showed that
the root of the problem lies in the immune system. Various cytokines are
liberated by the immune cells in the body in response to unidentified agents
causing rapid growth of skin cells in 2-3 days instead of the normal 21-28 days.
Link between psoriasis and other serious disease
Many
studies have found that psoriasis is associated with a number of potentially
serious medical conditions, including ischemic heart disease, stroke, diabetes,
metabolic syndrome and its various components (obesity, abnormal cholesterol,
glucose intolerance, hypertension), psoriatic arthritis, inflammatory bowel
disease as well as skin cancers. They are more than three times higher than the
general population to suffer a heart attack. Majority of these diseases can
have a significant impact on a patient’s overall health. Regular screening and
check up on the associated medical conditions are advisable.
Quality of life issues
Psoriasis
affects patients’ activities of daily living in many ways. Many patients felt embarrassed causing them
to avoid leisure activities and social interactions with others. This can lead
to low self esteem, anxiety, emotional stress, depression and suicidal. The skin
itchiness and pain cause sleep disturbance. The frequent peeling of skin can be
messy and patients may spend more of their time applying treatment to the skin.
Treatments
Various
treatments are available. The choice depends on various factors such as
severity of disease, age of patient, availability of drugs, tolerability,
patient’s preference and cost. Majority of patients have mild psoriasis which
can be treated effectively with topical application of creams or ointments. This
includes preparations containing steroids, tar, retinoids and vitamin D
derivatives. More resistant cases may need physical modalities such
phototherapy or excimer laser. About 10-20% of cases are severe that requires
oral medications. The conventional drugs include methotrexate, cyclosporine and
acitretin. Such drugs suppress the immune system and they require specialized
care with frequent monitoring of side effects. Often, combination of various
treatments may be required. More recently, biological drugs are available.
These are proteins or antibodies that are produced by biological engineering process.
They have good efficacy with fewer side effects. However, the long-term data on
their safety is still lacking. Currently, biologics are considered in cases
where patients failed to response to the conventional drugs or when potential
side effects occur with their use. The only set back is the cost of biologics
can be tremendous.
Challenges
Psoriasis is a
persistent disease with no cure at the moment. It is associated with various
medical conditions and has profound impact on patients’ quality of life. Various
treatments can help to control the symptoms, although this needs to be on
long-term basis. Many patients, in particularly those with severe disease, are
frustrated with the management of their disease and perceived ineffectiveness
of their therapies.
Take control
As psoriasis is a
life-long condition, it is important to learn more about the disease and be
active in managing it. Be knowledgeable about your options so that you can make
an informed decision and feel in control. Do not let psoriasis prevent you from
doing activities that you enjoy such as sports or traveling. Open up yourself,
talk to friends, family or join the support group. Live a healthy lifestyle by
having balanced diet, regular exercise and adequate sleep. Your symptoms can be
reduced if you get the right treatment and follow the treatment
recommendations. Consult your dermatologist to find a treatment plan that works
for you.
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