More Than Skin Deep

Psoriasis is a chronic inflammatory disease that not only affects skin and nails, but also other systems such as joints and eyes.

Characterised by salmon pink or red scaly plaques, these scales tend to form over the knee and elbow joints, lower back, shins, scalp and hairline. These plaques may or may not be itchy, but the constant flaking and shedding of scales, and the fissuring of dry skin, is a common complaint of psoriasis sufferers. Up to 40% of psoriasis sufferers may also develop inflammation of the joints or ligaments around the joints, resulting in arthritic aches and pains.

This is a condition that differs from many other skin conditions in that the inflammation is not limited to the skin alone. In fact, psoriasis is also associated with an increased risk of diabetes, hypertension, obesity and cardiovascular disease.

Depending on the precise nature of the condition, it may be categorised into different types including palmoplantar psoriasis (where hands and feet are involved), flexural psoriasis (where skin folds such as the groin, underarms and under the breast are affected), guttate psoriasis (where there are numerous small and widespread plaques resembling raindrops on the skin) and pustular psoriasis (where the plaques are studded with numerous small pustules that may be painful).

Depending on the type of psoriasis, the type of treatment will vary. Topical therapy such as topical steroids, coal tar, vitamin D analogues and combination creams may prove useful, as may UVB phototherapy (where the patient is exposed to a short burst of specialised light).

If the condition is relatively severe – especially if it includes arthritic symptoms – systemic therapy may be required in the form of drugs such as methotrexate, cyclosporin and acitretin. If the psoriasis does not respond to conventional systemic therapy, or if there are unacceptable side effects to conventional systemics, injectable biologics – where the drugs are created by biological processes – may be a viable option as well.

Of course, the patient’s lifestyle should also be taken into consideration. If the patient drinks excessively or smokes, he/ she should take steps to control that. Proper stress management is also of the paramount importance, and if associated medical conditions such as hypertension, diabetes or obesity are detected on screening, steps should be taken to bring them under control as they may worsen or complicate the treatment of the patient’s psoriasis.