Psoriasis - A chronic rash that is more than skin-deep!
Psoriasis patients need to go for screening as they have twice the risk of metabolic syndrome.
One of my
patients said that everyone got out of the condominium pool the minute they saw
him entering it. He now swims only late at night, when there is no one
around.
It is
disheartening to see people with non-infectious skin diseases, such as
psoriasis, shunned and discriminated against in public. Psoriasis can
affect any part of the body, including the scalp and genital regions. Up
to half of psoriasis patients may have nail changes and one-third of them may
have painful, swollen joints.
Psoriasis
affects about 100 million people worldwide, according to the World Health
Organization.
The
condition is non-contagious. But due to poor public awareness and the
unsightly appearance of the rash, people with psoriasis are often stigmatized.
In a survey
conducted by the Psoriasis Association of Singapore in 2015, about half of the
respondents said they would not eat food prepared by people with psoriasis,
share a workplace or residence with them, or allow their children to play with
them.
I have
encountered many patients who have difficulty getting jobs. There is a
high chance that they would be rejected when any prospective employer learns
about their psoriasis condition.
Mr. L, a
52-year-old driver, came to see me recently as his psoriasis had deteriorated
in the past few months - the rash was covering more than 20 per cent of his
body surface area. He has had psoriasis for the past 10 years and was
previously treated with topical creams and lotions prescribed by his family
doctor. However, he did not follow up on the treatment. He had also
not gone for health screening for several years, as he felt well and did not
have symptoms such as joint pain.
A heavy
smoker who had been puffing about 20 cigarettes a day since his teenage years,
he rarely exercised. He also drank alcohol occasionally. As I was
preparing to start him on an oral medication to treat his psoriasis, I did some
checks. I discovered that he had diabetes mellitus, as well as
hyperlipidaemia and hypertension. He was dismayed when I informed him
about this.
In recent
years, research has greatly advanced our understanding of psoriasis. We
now know that psoriasis is not just a skin disease per se, but one that is
associated with nearly twice the risk of metabolic syndrome (a group of
cardiovascular risk factors, including hypertension, insulin-resistant diabetes
and abdominal obesity), ischemic heart disease and stroke. The greater
the severity of psoriasis, the higher the risk. Other conditions that
share a link with psoriasis include non-alcoholic fatty liver disease,
inflammatory bowel disease and depression.
It is very
important for people who have psoriasis to undergo annual health screening and
to lead a healthy lifestyle.
At the
National Skin Centre, we routinely screen psoriasis patients for metabolic
syndrome once a year. As for Mr
L, I encouraged him to exercise regularly, control his diet and quit or, at
least, cut down on smoking and alcohol. He agreed to see his family
doctor for treatment and follow-up on his metabolic syndrome.
A SILVER LINING
Although
psoriasis is a chronic skin disease with no permanent cure, there are numerous
treatment options that offer patients a reasonably good chance of suppressing
the disease and leading a normal life.
Topical
creams and lotions are used for patients with very mild psoriasis. For those
with moderate to severe psoriasis, treatment methods include ultraviolet light
phototherapy and oral medication.
The
medication contains ingredients that aim to suppress skin inflammation and
normalize the growth rate of superficial skin cells, which are both markedly
increased in psoriasis.
As these
medications carry a potential risk of side effects, such as decreased
production of blood cells, kidney problems or liver damage, patients need to go
for regular blood tests to check for these effects. Newer
treatments, such as biologic agents that work by blocking specific immune
pathways that drive psoriasis, have been proven to be generally effective and
safe for most people.
There is,
however, a slightly higher risk of infections. These biologic agents are
administered via injections, ranging from once every two weeks to once every
three months.
For the
patient to continue experiencing its benefits, the treatment needs to be
continued long term.
Psoriasis
is a serious disease that goes beyond being skin-deep.
Early
diagnosis and appropriate treatment tailored to each patient will ultimately
make a positive difference to his/her lifespan and quality of life.
Source
of information: Dr. Eugene Tan Sern Ting is a consultant dermatologist at the
National Skin Centre, National Healthcare Group, Singapore.
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