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At War with the Skin

A consultant dermatologist explains how psoriasis can affect the skin and what can be done to treat this condition.

FIVE THINGS ABOUT PSORIASIS

1) Psoriasis is not simply a skin disease. It is an auto-immune disease, which arises when something goes wrong with the immune system. People with this condition have raised red, scaly patches (or plaques) on their skin.

2) About 1-3% of Malaysians are affected, and psoriasis can affect both adults and children of both sexes.

3) About 30% of people with psoriasis will develop psoriatic arthritis, a condition that can cause joint pain, stiffness and swelling. Movement becomes difficult and often painful, and joint deformities may arise.

4) There are long-term affects on the health. In addition to psoriatic arthritis, untreated psoriasis is also linked to increased risk of diabetes, obesity, cardiovascular disease and stroke. Young people with psoriasis, especially more severe psoriasis, are at higher risk of having reduced life span.

5) One cannot catch psoriasis from other people. Thus,if psoriasis affects you or your loved one, it is important to get proper medical attention and treatment as early as possible.

 

THE BURNING ITCH

  • Up to 90% of people with psoriasis can experience itch as a constant frustration in their lives. This itch is a burning and sometimes painful sensation, comparable to bites of fire ants.
  • Itch can be triggered by stress, so yoga, medication and other relaxation therapies can be useful. Regular exercise and counseling can also help.

 

BLOW TO THE SELF-ESTEEM

  • Psoriasis can affect a person ability to socialize, form romantic relationships and find employment. This leaves him or her vulnerable to depression and destructive behaviour such as drug abuse and alcoholism.
  • A published review in the American Journal of Clinical Dermatology suggested that “social stigmatization, high stress levels, physical limitations, depression, employment problems and other psychosocial co-morbidities experienced by patients with psoriasis are not always proportional to, or predicted by, other measurements of disease severity such as body surface area involvement or plaque severity. Thus, the severity of psoriasis will not be made based only on physical examination. The dermatologist will also evaluate the impact of the condition on your quality of life.

 

TREATMENT FOR CLEARER SKIN

There are a number of treatment options available for psoriasis. It is not unusual for the dermatologist to change to a different treatment if a patient is not responding adequately to his or her current treatment.

Topical treatments. These are the creams, ointments and lotions that can be applied onto the affected areas of the skin.

  • Those containing peeling agents such as salicylic acid help to soften psoriasis scales, making them easier to remove.
  • Moisturizers are important to prevent dry skin, which tends to be itchy and may worsen psoriasis.

Light therapy (phototherapy)

Ultraviolet light B (UVB) is targeted at affected areas to slow the growth of skin at the affected areas. This is an effective treatment, but the patient needs to receive it consistently for best results.

Medication. Methotrexate is a commonly prescribed medication : it has been found to be effective for many patients and the number of patients and the number of patients that experience side effects is relatively small. It is also a cost-effective medication. However, it may cause side effects such as liver problems, so it may not be an option for some patients. Aside from methotrexate, cyclosporine and retinoids are also some examples of more conventional medications.

Recently, another type of medication, called biologics, has been developed. Biologics are bioengineered medications that target specific pathways in the immune system. Because psoriasis is a condition caused by abnormal workings in the immune system, biologics can be more effective, accurate form of treatment. Some examples are etanercept, infliximab, adalimumab and ustekinumab. Biologics are usually injected into the skin or administered intravenously (through a drip).

New medication offers better hope for clear skin

Secukinumab is a biologic that binds specifically to a protein in the body called interleukin-17A (IL-17A), stopping its activity and reducing symptoms very effectively.

  • 8 out of 10 patients achieved clear or almost clear skin with 90% skin clearance (PASI 90).
  • 83% of patients were able to maintain 75% skin clearance (PASI 75) for up to three years.
  • Clinical trials on more than 4,000 patients found that its safety profile is similar to other biologics in the market.

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