Psoriasis ― Not just a skin disease

Psoriasis is a chronic, long-standing, non-infectious, non-contagious, immune-related disease that affects mainly the skin but also the scalp, nails, and joints.

Caused by a combination of genetic and environmental factors

There is no such thing as a flawless individual. However, as long as the flaws are related to society norms, we have learned to overlook them. Certain groups, on the other hand, are frequently stigmatised. Individuals diagnosed with a skin disorder known as ‘psoriasis’ are among the many who have to face the weight of society.

Consultant dermatologist Dr Felix Yap.

According to consultant dermatologist Dr Felix Yap, psoriasis is a chronic, long-standing, non-infectious, non-contagious, immune-related disease that affects mainly the skin but also the scalp, nails, and joints.

“On the skin, immune dysregulation causes inflammation of the second layer of the skin (dermis) with increased production of cells in the upper layer (epidermis), causing thickening of the skin,” and this will lead to patchy red skin thickening with white silvery scales, said the doctor. 

These skin lesions might be itchy, but they aren’t always, according to Dr Yap. “They’re most commonly seen on the body’s extensor surfaces, such as the elbow and kneecap, scalp, navel, buttock cleavage, lower back, and legs.”

Psoriasis patients, on the other hand, may identify signs through changes in their nails.

Onycholysis, the separation of the nail plate from the nail bed on the edges of the nail; bleeding, salmon spots on the nail, and nail thickening are all examples of “pitting,” where small dots on the nail plate appear to have been hammered with. These nail diseases are usually associated with joint involvement.“

Dr Yap explained that joint involvement in psoriasis was linked to immunological dysregulation.

“Joint pain, stiffness, and swelling are common symptoms. Not only is the joint inflamed with psoriasis, but the ligament that inserts into the joint, called the enthesis, is also inflamed. Swelling and discomfort are common symptoms of enthesitis. It causes sausage-like digits in the fingers and toes.

“The common presentation includes one joint pain mimicking gout, multiple small joint pains in the hands and feet mimicking rheumatoid arthritis and back pain,” he added. 

The cause of psoriasis

The skin disorder, which affects people between the ages of 50 and 69, is caused by a combination of genetic and environmental factors, according to Dr Yap. “There have been numerous discoveries of genes linked to psoriasis. Psoriasis can be caused by environmental factors such as infection, stress, smoking, alcohol, and drugs such beta-blockers (a type of hypertension treatment) and chloroquine.”

According to Dr Yap, psoriasis is a serious health condition. Psoriasis — which involves skin and nail lesions — can cause infection, quality of life concerns, image issues, stigmatisation, and depression, so it is important to educate people about it. In addition, psoriasis promotes joint illness, which can result in disability.

“Psoriasis is linked to metabolic disorders such diabetes, high blood pressure, and obesity. This could result in cardiovascular problems such as heart attack and stroke.”

When first spotted, psoriasis may appear as skin lesions but it is smaller and less scaly. However, as time passes by, psoriasis expands, becoming thicker, redder, and scalier. As for joint pain, Dr Yap shared that it tended to be mild with less stiffness during the initial stage, but it would get worse in later stages.

“Psoriasis is serious. If it goes undiagnosed, the patient will increase their risk of severe cardiovascular disease and disability due to joint and nail disease,” the dermatologist added.

Psoriasis is usually located on the extensor surfaces of the body, such as the elbow and kneecap, scalp, navel, buttock cleavage, lower back, and legs.

The further effects of psoriasis and its treatment

According to Dr Yap, psoriasis becomes worse when the patient is also diagnosed with obesity. “Aside from that, smoking and alcohol also worsen psoriasis,” he said.

As psoriasis affects the physical appearance of an individual, there are several aspects to consider as the further effects of the skin condition. Among the two major categories are those under the mental health and physical health of the person.

With years of experience in the field, Dr Yap said that under the mental health category, patients are often ridden with anxiety, depression, stigmatisation and social isolation. As for physical health, psoriasis affects a person by causing disability due to pain, infection, metabolic syndrome, and cardiovascular disease.

For skin diseases such as psoriasis, there are multiple treatment options available. Dr Yap shared that for those with mild conditions, the lesions could be treated with topical creams including steroids, tar, and vitamin D cream. “For more severe diseases, phototherapy, immune suppression medications and biologics are warranted.”
Dr Yap went on to say that biological treatment has revolutionised the management of psoriasis, allowing total clearance of both the skin and joint disease, which is rare with conventional medications.”It is also far safer than conventional immunosuppressive medications.”

Psoriasis and COVID-19 vaccinations

Consultant Dermatologist Dr Peter Ch’ng.

Consultant dermatologist Dr Peter Ch’ng explained that COVID-19 vaccines were safe for psoriasis patients. As such vaccinations are vital during a pandemic, the risk of not getting them far outweighs the risk of not getting them.

“The current data and evidence suggest that COVID-19 vaccines are effective and recommended for psoriasis patients.

“The likelihood of having poor outcomes from COVID-19 is driven by risk factors such as older age and comorbidities such as chronic heart disease and metabolic disorders such as diabetes and obesity,” he said. 

Because patients with skin illness are more likely to develop these comorbidities, Dr Ch’ng advises that everyone get the COVID-19 vaccine. Asked whether the vaccine would weaken the immune system, Dr Ch’ng said no. “Vaccines are designed to boost your immune system’s ability to fight the virus and reduce the severity of the sickness.”

Fever, painful arms, and fatigue are all frequent side effects in people with psoriasis, just as they are in healthy people. “These symptoms are normal and indicate that the body is developing resistance to COVID-19.

“Some people may experience modest psoriasis flare-ups after immunisation, but most of the time it can be controlled using topical treatments.”

Nonetheless, Dr Ch’ng encourages speaking to a dermatologist prior to the vaccination to learn more. 

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