Fight the Psoriasis Flake

Debunking myths on psoriasis

Although psoriasis affects between 2% of the population in Singapore and Malaysia, there is still much confusion over this common condition. To get the facts straight, we interview Consultant Dermatologist, Dr Lynn Chiam, from the Children and Adult Skin Hair Laser Clinic, who puts some common misconceptions about psoriasis to rest.

Myth 1: There is only one type of psoriasis

Dr Chiam: There are actually seven types of psoriasis:

1. Plaque psoriasis. 2. Inverse psoriasis. 3. Nail psoriasis. 4. Guttate psoriasis. 5. Erythrodermic psoriasis.

Plaque psoriasis – affecting 80% to 90% of people with psoriasis, it is characterised by raised red patches with silvery, flaky skin that can develop anywhere on the body – including the head, elbows, knees, back, hands, belly button and behind the ears. These patches are usually itchy, resulting in skin that’s often irritated and damaged from scratching.
Inverse psoriasis – also known as flexural psoriasis, this variation develops in the skin folds along the groin, buttocks, armpits, genitals and under the breasts. Its symptoms are usually less scaly with fewer plaques as the skin is less dry and experiences more friction than exposed skin.
Nail psoriasis – affecting between 10% to 55% of cases, this results in nails that develop small scattered indentations, grow thicker, turn yellowish-brown and become loose.
Pustular psoriasis – characterised by pus-filled blisters, this can occur on its own or with plaque psoriasis.
Guttate psoriasis – although uncommon, guttate psoriasis can cause large-scale acute rashes with small, drop-like bumps. Mostly seen in children and teenagers, it usually occurs after bacterial infection of the throat, such as by streptococcus, and may completely heal or return as plaque psoriasis.
Erythodermic psoriasis – the rarest form of psoriasis, its symptoms include red, peeling, itching and burning rashes that cover the entire body.
Psoriatric arthritis – a form of arthritis that affects people with psoriasis, this can cause swollen and painful joints, which may progress to joint stiffness and permanent joint damage as the condition progresses.

Myth 2: Psoriasis is contagious and caused by poor hygiene

Dr Chiam: Psoriasis is neither infectious, nor associated with poor hygiene. In fact, researchers believe it’s caused by immune system dysfunction triggered by genetic and environmental factors.

In normal skin, skin cells on the epidermis are replaced every three to four weeks. In patients with psoriasis, their immune system goes haywire, causing skin cells to regenerate at a much faster rate. Once this happens, dead skin cannot shed as quickly as new ones are produced, resulting in skin that’s thick, flaky and crusty. Psoriasis skin also appears red due to the various inflammatory processes that play a key role in the condition’s development.

In some cases, people predisposed to psoriasis may only experience symptoms after the condition is triggered by environmental factors including:

Infections, such as strep throat
Cold, dry weather
Skin injury involving a cut, scrape, bug bite, or severe sunburn
Stress
Smoking/ exposure to secondhand smoke
Binge drinking
Certain medications (lithium, beta blockers, antimalarial drugs)
Rapid withdrawal from oral corticosteroids

Myth 3: Psoriasis is curable

Dr Chiam: There is no cure for psoriasis. However, we can control it with prescribed treatments tailored to the type/severity of psoriasis, as well the area of skin affected. In most cases, doctors will prescribe mild treatments, progressing to stronger treatments if the condition does not respond as intended. These solutions in order of intensity involve:

Skincare: Ointments, creams and lotions keep skin supple, protect it from injury and relieve itching. Ingredients such as urea and salicylic acid also reduce shedding.
Topical treatment: Products with corticosteroids and vitamin D slow immune cells in the skin, and ease swelling and redness. Although effective, steroids have side effects and should not be used on sensitive areas such as the face or genitals without a doctor’s prescription
Immunosuppressants: Immunosuppressants such as pimecrolimus or tacrolimus are prescribed for areas where skin is sensitive, as they are not steroids, but are still effective in changing how your immune cells work.
Coal tar ointment and shampoo: Coal tar eases psoriasis-related inflammation, itching and scales. However, it may cause skin redness and dryness, and increase your skin’s sensitivity to UV light. These are not recommended to pregnant or breastfeeding women.
Light therapy: UV therapy reduces inflammation and slows cell production. Medication such as psoralen may be used with light therapy as it increases the skin’s sensitivity to light. Best for people with moderate/severe psoriasis whose conditions do not respond to conservative treatment, it is considered safe for children, pregnant/breastfeeding mothers and those with weakened immune systems.
Oral/injected medications: Oral medications such as methotrexate, cyclosporin and acitretin, as well as biologics (administered through injection) improve symptoms by inhibiting the immune response. Recommended for people who do not respond to conservative treatment, regular blood tests are needed while on oral medications, while biologics must be used with caution as it can bring rise to serious infection.

Myth 4: Psoriasis is preventable with good habits

Dr Chiam: Although psoriasis cannot be prevented, you can avoid flareups by steering clear of its triggers. I recommend:

Reducing alcohol and nicotine use
Avoiding injuries or infections that promote psoriasis
Applying moisturisers regularly
Maintaining a healthy weight, as obesity is related to poorer response to treatment
Checking with your doctor if current medications exacerbate your psoriasis

Myth 5: Psoriasis and eczema are the same condition

Dr Chiam: Despite being different skin disorders, with different underlying causes, psoriasis and eczema can present with similar red, itchy and flaky rashes that lead to skin infections. As they can appear similar, it can be difficult to distinguish between these conditions, especially to an untrained eye. This is why I recommend for all patients with skin problems consult a board-certified dermatologist to accurately diagnose your symptoms and prescribe the most suitable treatments for your needs.