Dermatitis: Psoriasis Types and Treatment

Did you know that it is estimated that up to 500,000 to 800,000 of Malaysians are affected by psoriasis? 85% of our population had experienced some degree of humiliation and discrimination. This contributes to many negative effects on work, intimate relationships, sleep and mental health. In conjunction with World Psoriasis Day, let’s get to know this illness better and help people combat the disease in a more conducive environment.

Psoriasis is a chronic inflammatory skin condition. It is characterized by symmetrical, well demarcated, scaly erythematous plaques. Nail, scalp, lower back, gluteal, genitalia and extensors of the upper elbow, shin, knee are common areas of distribution. Occasionally, genitalia, intergluteal folds and folds under the axillary, breast and groin can also be affected. This disease is not just a disease of the skin, but also affecting the joints, also known as psoriatic arthropathy. Patients with this illness are at increased risk of stroke, heart attack and mental illness.

What are Psoriasis Types?
Five different types of psoriasis are identified, namely

• Plaque psoriasis
• Erythrodermic psoriasis
• Flexural psoriasis
• Pustular psoriasis
• Guttate psoriasis.

Nearly 80% of the psoriasis identified are plaque psoriasis. Typical age of onset in Malaysia is around 30-40 years old. Those who have a family history of psoriasis may have an earlier age of onset.

Psoriasis Treatments
Treatment of psoriasis is in accordance with the severity of the condition.

1. Topical treatment -remains the most important management option. Topical corticosteroids are usually prescribed as the first line treatment, as this drug has been used for more than 5 decades with a well-known safety and efficacy profile. However, worth mentioning, systemic corticosteroids may initially improve the skin lesion yet later on causing worsening of existing lesions. Thus, this route of administration shall strictly be prescribed by only the professionals for limited indications. Non-steroidal options, named calcineurin inhibitors, are available. However, the current evidence of its use is only over the face, neck and flexural area. Other local application options include vitamin D derivatives, keratolytic agent, tar and its derivatives, and vitamin A derivatives.
2. Physical treatment – phototherapy and excimer light/ laser can be used for moderate to severe psoriasis. Depending on the machine, this remedy can be used to treat mild to moderate disease. This modality may spare the need of enteral or parenteral needs of medication, therefore sparing the potential systemic medication complications. The downside of this therapy is that it requires a two to three times clinic visit per week, limiting it from those with a busy schedule. Systemic medications such as methotrexate, cyclosporine and acitretin had been used for decades. These medications may warrant more frequent drug monitoring to allow early detection of potential complications from these medications. This drug may potentially be teratogenic, thus limiting its use among the young adults. The good news is, major advances have been made in psoriasis management for the past one decade. Recently developed biological drugs allow hope for clear or possibly clear skin. Nonetheless, finances are a major hindrance for this treatment.

What is the Psoriasis Diet?
The role of diet in psoriasis is still lacking in evidence. Nevertheless, knowing that this skin disease is worse among those with obesity, a clean and lean diet should be practiced. It is crucial for psoriasis patients to remain active and try their best to achieve a normal body mass index. This is because losing weight itself is found to help in reducing the disease severity. High sugar, high salt diets should be avoided, as this will put you at a higher risk of diabetes and hypertension, a well-known risk for stroke and heart attack. If you are suffering from psoriasis, maintaining an active lifestyle will help reduce its associated morbidities.

Last but not least, psoriasis is not just a skin disease. It is associated with psoriatic arthropathy and many other systemic and psychological illnesses. Recent advances allow better treatment for psoriasis. You don’t have to suffer the illness by yourself! Talk to a professional to have a better understanding of your disease and treatment options available. Choose one that suits you the most. Most importantly, do not give up too soon as the majority of those who finally achieved a successful control required at least a year before an efficacious remedy was finally found.

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Dr How Kang Nien,
Consultant Dermatologist,
Tung Shin Hospital,
MBBS (UM); MRCP (UK) (Sce Dermatology); ADV M Derm (UKM)