What’s the first thing that comes to your mind when you see a person with reddened skin patches all over their arms? Eczema, right? But wait. It could also be something more severe called psoriasis. Unlike eczema which is inflammatory in nature, psoriasis is more of an autoimmune disorder whereby the body’s own immune system attacks healthy skin and joint tissues.
This chronic, non-infectious yet painful and disabling disease is said to affect about 2% to 3% of the world’s population in two different age groups; the early onset at < 40 years of age and the late onset at > 40 years of age. Due to the variable degrees of severity, psoriasis can cause significant physical, psychosocial and economic impact on patients in a negative way.
While the actual cause is yet to be determined, evidence from research suggests that genetic could be linked to the occurrence of the disease. For example, a child has about 28% chance of getting psoriasis if one of the parents is diagnosed with the condition. If both the parents exhibit the disease, the heredity risk goes up by 68%.
Apart from that, several factors such as obesity/weight gain, tobacco smoking, skin trauma, Streptococcal (bacteria) throat infection, periodontitis (inflammation of the tissue around the teeth), stress, sunburn and certain drug usage have been found to trigger or aggravate the disease condition, making it more complex to manage.
In Malaysia, this immune-mediated disease can manifest on the skin, nails and joints with the following clinical features:
An experienced dermatologist should be able to correctly diagnose psoriasis based on some history taking and physical examination. By looking for clues from your skin, nails and scalp, they should be able to stage the severity of the disease and implement an individualised treatment plan to relieve the symptoms and prevent the disease from worsening to the arthritic stage.
Topical corticosteroids, vitamin D analogues and keratolytics are usually used as first-line therapies for treating mild-to-moderate psoriasis. On the other hand, severe cases are usually treated with phototherapy (exposing the skin to ultraviolet light) and systemic therapy using anti-inflammatory drugs, biologic agents and oral small molecules.
Despite the current standard of health care, the World Health Organization (WHO) acknowledges that psoriasis cases are widely misdiagnosed and many patients suffer needlessly due to delayed diagnosis, inadequate treatment options and insufficient access to proper medical care. Therefore, it is important to raise awareness of the disease among health care professionals and the general public in order to provide adequate support for patients throughout their ordeals.
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