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Kim Kardashian has been pretty vocal about the autoimmune disease that she has — psoriasis. It is a chronic inflammatory disease that affects their skin, scalp, nails, joints, and even their metabolic status.

Psoriasis affects an estimated 3% of the world’s population, and is one of the top ten skin diseases in Singapore. Dr Lim Chun Siong, Vitiligo, Psoriasis & Skin Clinic by DTAP Clinic, shares what you need to know about this disease and how to control flare-ups.

What is psoriasis?

Psoriasis is an autoimmune disease, and so it means in sufferers, their own bodies’ immune cells starts to attack various parts of their bodies, such as joints, tendons, skin and more.

When psoriasis attacks joints and tendons, it may lead to joint pain, stiffness or even deformity if not treated early. This happens in as many as one third of people with psoriasis.

Psoriasis on the skin and scalp appear as flaky, thick patches that can itch or even become sore. Apart from the discomfort, these rashes can be disfiguring and embarrassing if they appear on exposed parts of the body like the face, neck, arms, or legs.

A patient said she stopped going to the beach and wearing dresses and halternecks since she developed psoriatic plaques on her arms, legs, and back.

Psoriasis on the scalp can itch, and may give rise to flaky dandruff and even cause hair thinning.

Psoriasis on the nails can range from the appearance of small pits to problems such as nail discoloration, abnormal nail growth, a separation of the nails from their beds, and even crumbling of the nails in severe cases.

Perhaps not very well known is psoriasis’ association with obesity, high blood pressure, high cholesterol, diabetes, heart disease, stroke, and fatty liver. People with psoriasis have a higher chance of developing these conditions which can have adverse health impacts of their own.

This is especially worrying as the SARS-CoV-2 virus causing COVID-19 seems to be especially detrimental to people with such conditions as high blood pressure, high cholesterol, diabetes, and heart disease.

Rare complications can sometimes occur where psoriasis affects so much of the body that the whole body turns red, a condition known as erythroderma. Urgent treatment is often necessary if it happens.

Is there a cure?

There is no cure for psoriasis. The disease can last a lifetime.

However, there are differences in the severity of symptoms or suffer the same symptoms among people with the disease. Symptoms may change in severity through the years. It is typical for a person to be cleared of psoriasis after treatment only to see a relapse sometime later. This waxing and waning nature of the disease is a source of frustration even for people with mild psoriasis.

Because of the visible disfiguration, psoriasis can impact a person’s way of life at work, at school, in relationships, and emotional well-being. Studies have shown that psoriasis can negatively affect the physical, psychological and social well-being of individuals as much or greater than major medical diseases like heart attacks, cancer, diabetes, and chronic lung disease.

Several forms of treatment are available to improve the physical symptoms of psoriasis.

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Anti-inflammatory creams containing coal tar, vitamin D or corticosteroids, as well as ultraviolet light therapy can improve the skin rash and itch of psoriasis. More severe psoriasis is often treated with oral medications that suppress the immune system.

This helps to quell the autoimmune attacks and inflammation and allow the body tissues a chance to recover. Oral medicines can have various side effects depending on the particular medication in use and regular blood tests are usually recommended to monitor for potential toxic effects on internal organs.

The newest and perhaps the most effective treatment for moderate to severe psoriasis are a class of injectables known as biologics. These are genetically engineered proteins that target specific parts of the immune system found to be active in psoriasis. They are able to treat almost all symptoms of psoriasis but are costly and may potentially increase one’s chance of getting a bacterial or viral infection or activate hidden diseases like tuberculosis, due to the immunity suppression properties.

A typical treatment duration can vary from a few months to a year and beyond. Although biologics are effective, they are not a cure and relapses can still happen after a treatment. More research is necessary to understand this disease better, produce better treatments, and hopefully a cure.

Psoriasis presents life challenges to people suffering from the disease. However, there are certain things you can do to help make your life easier if you suffer from it.

How to control your symptoms

Learn how to control your symptoms well by treating flare-ups early, avoiding triggers, practising good skincare and adopting a healthy lifestyle.

Having standby medication at home to treat a flare-up once it starts can often help nip it in the bud and save a visit to your doctor. Infections, skin injury, weather, emotional stress, smoking, alcohol consumption and certain medicines can trigger psoriasis. Knowing what triggers psoriasis and keeping those things at bay is important.

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Regular use of moisturisers on your skin is a good habit to adopt as it helps to reduce itching and softens the plaques. Daily baths can help remove scales. Regular exercise, eating a healthy balanced diet, refraining from smoking and alcohol can help improve symptoms, mental health, reduce stress and reduce your chances of developing other chronic illnesses that are associated with psoriasis.

Managing stress triggers

Stress can trigger psoriasis, and psoriasis can conversely also cause stress. People with psoriasis are more likely to become depressed. Some of the symptoms of depression are: lack of interest in things that you used to enjoy, inability to focus, loss of energy, inability to sleep, feeling that you cannot get out of bed.

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Hence it is helpful to learn how to manage stress through relaxation techniques, meditation, and exercise. Consider attending counselling sessions on stress management. Please talk to your doctor early if you suspect you may suffer from depression.

Joining support groups

Join support groups to learn more about the disease, connect with others in similar situations, share experiences on how to cope with psoriasis and make friends along the way.

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One such group is the Psoriasis Association of Singapore. Learn as much about psoriasis as you can from qualified sources like your doctor, so that you can better manage this chronic condition through prevention of flare-ups, mitigation, and lifestyle improvement.

Always seek help early if you need to. You are not alone.

Text: Dr Lim Chun Siong / Her World