Psoriasis

Written by Dr Kwan Zhenli
MBBS (Malaya), MRCP (UK), Adv M Derm (UKM), SCE Derm (UK), FRCP (Edin), AM (Malaysia), Fellowship in Mohs & Adv Derm Surg (UK)

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What is psoriasis?
Psoriasis is an inflammatory long-term skin condition that affects 2-4% of the population.

What causes psoriasis?
Psoriasis is caused by immune system over-activity related to genetic and environmental factors. Triggers may include infections, medications, ultraviolet light, low-grade inflammation, injury, alcohol consumption, being overweight, smoking and stress.

What does psoriasis look like?
Skin affected by psoriasis typically looks like pink, red or darker thickened areas with silvery scales. Common sites include the elbows, knees, belly button, lower back and scalp. Severe psoriasis can affect nearly all of the skin and these patients may need to be hospitalized for treatment. Some patients with psoriasis may also develop pustules.

Psoriasis may affect the nails and cause lifting of the nail, indentations, ridging, discoloration, thickening and yellowing of the nails and complete nail destruction.

Some patients with psoriasis may develop joint pain, swelling and stiffness.

How can psoriasis be treated?
1. Topical treatments may include creams, ointments, gels, pastes, foams and lotions. Some of the topical medications commonly used include tar, topical steroids, vitamin D3 analogs and topical calcineurin inhibitors (tacrolimus, pimecrolimus).

2. Phototherapy is the use of ultraviolet light to treat psoriasis.

3. Internal treatments
Internal (systemic) treatment options can range from tablets (such as methotrexate, acitretin, ciclosporin and apremilast) to injections (such as adalimumab, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, ixekizumab, risankizumab, secukinumab, tildrakizumab and ustekinumab). Patients on internal treatments will generally require monitoring by the doctor and this may also include blood tests.

What lifestyle changes can help to improve psoriasis?
People with psoriasis can take the following steps:
- Adopt a healthy lifestyle including diet and exercise
- Stop smoking
- Reduce alcohol intake
- Reduce stress
- Keep your skin moisturized