Skip Ribbon Commands
Skip to main content

Going beneath the surface

Myths and misconceptions about psoriasis can result in affected individuals having to live with stigma and an unhealthy social well-being. In conjunction with Psoriasis Awareness Month in August, learn more about this skin condition that affects over 40,000 people in Singapore.

Ms Nathan believes that patients with psoriasis can still enjoy and live life to the fullest.

The skin on her arms and legs was often scaly and red, and the appearance and texture of her nails were badly affected, making them bleed and difficult to cut. There was thick dry skin under her nails, and the cuticle was growing underneath, pushing her nails upwards and outwards.

Ms Florence Nathan, 70, has been living with a condition known as psoriasis for 40 years. Thankfully for her, her family and friends have never treated her any differently all these years despite her appearance. The sprightly senior believes in living her life well, instead of cooping herself up. Many other psoriasis patients — particularly those whose condition is severe — are prone to feeling embarrassed and even ashamed of their appearance, which in turn, adversely affects their confidence.

Psoriasis presents itself in the form of salmon pink lesions with scaly surfaces, and tends to affect the elbows and knees symmetrically. It can also be found at, and affect, the hairline, trunk of the body and nails. When psoriasis occurs at the nails, pitting, discolouration, thickening of the nails and separation of the nail from the nail bed might occur. Psoriatic arthritis can also occur in some patients — about a quarter of patients have joint problems associated with psoriasis, and this may sometimes cause joint deformity if left untreated. Psoriasis has many associated co-occurring conditions, including psoriatic arthritis, cardiovascular diseases, metabolic syndrome, inflammatory bowel disease and depression.

The development of psoriasis is caused by genetic and environmental factors. Many patients have a family history of psoriasis. Environmental causes can include reactions to certain medications, infections and skin trauma, as well as physical, mental and emotional stress. Psoriasis is not infectious and cannot be spread to others.

Saving one’s skin: Identifying and managing psoriasis

“Psoriasis is sometimes mistaken for eczema as both can result in a dry, itchy and scaly rash,” says Clinical Assistant Professor Tan Ki Wei, Chief and Senior Consultant of Changi General Hospital’s (CGH) Department of Dermatology. “However, psoriasis usually presents as well-demarcated scaly plaques and may affect the knees and back of the elbows, while eczema is less defined, dry and affects the skin folds.”

Fungal infections that affect the skin may sometimes look very similar and additional tests, like skin scraping tests, may need to be done. At CGH, a clinical diagnosis is carried out to determine if the issue is psoriasis. A diagnosis is usually made on the typical appearance and location of the rash, after taking a detailed history and performing a physical examination on the patient.

Presently, there is no permanent cure for psoriasis, but there are treatments that can help manage the condition. These range from moisturisers, steroid creams and vitamin D analogue creams to oral immune suppressants, biologic drum injections and phototherapy.

Besides taking prescribed medication and applying creams, Ms Nathan has been undergoing phototherapy sessions at CGH to help manage and treat her psoriasis over the years. Also known as light therapy, phototherapy makes use of different wavelengths of ultraviolet light, helping patients’ skin produce more vitamin D, which can help reduce itch and inflammation. “Treatment should be individualised and tailored according to a patient’s specific condition and its severity. A holistic treatment approach can help enhance the quality of life for patients with psoriasis,” says Clin Asst Prof Tan.

Ms Nathan’s lesions and scarring have gotten better. “Dr Tan and his team have been patient and very encouraging, and above all, they ensure that I receive the best treatment and that I am comfortable and aware of all the treatments and medication,” she shares. After all these years, she has learnt to live confidently with the condition. “Since being diagnosed with psoriasis, I have learnt not to be conscious of the lesions and scars,” she adds. “When others ask what they are, I bravely tell them about it, and after that they no longer bring it up. I want to encourage others with psoriasis to not let it stop you from enjoying life and living life to the fullest.”

Going beneath the surface