The Straits Times
Mind Your Body | Health Help | Doc Talk By Dr Jean Ho
Oct 1, 2009
What is that rash on your hand? It is a question Mr Lim has been asked umpteen times by cabbies, at job interviews or when out with friends.
‘It’s psoriasis,” he would reply, when he chooses not to ignore the question.
Sure enough, the next question would be: ‘Sora… what? Have you seen the doctor? Is it contagious?”
His psoriasis began 17 years ago, after his 50th birthday. The skin condition came about without warning, covering much of his body with red flaky and itchy rashes. At times, it was hot and burning; at other times itchy.
His palms and soles became so thick that deep painful cracks would appear.
Clearly, his red, blotchy and flaky skin caused him some embarrassment. The flakes were everywhere – on the chair, in the bathroom and on the floor.
He resorted to wearing long-sleeved shirts and long pants when he was out. However, the red scaly skin would show up on the back of his hands, which remained exposed. His nails were also disintegrating.
Psoriasis affects nearly 3 per cent of the world’s population. It is a chronic disease which is highly visible and often disfiguring. It causes red, scaly patches called lesions to appear all over the skin.
There are several different patterns of psoriasis.
Plaque psoriasis is the most common and it affects the outer surfaces of the arms and legs.
Sometimes, little pockets of pus can appear anywhere on the body. This form is referred to as pustular psoriasis and can cause the patient to feel sick and feverish.
The most debilitating and painful type is erythrodermic psoriasis. The whole body will look very red and swollen, with lots of shedding of dead skin.
No one knows exactly what causes psoriasis. It can affect the young and the old.
The disease may be genetic, that is, it runs in families. Termed polygenic, this means that not one, but several different genes are responsible for causing the disease. The right or wrong combination of genes can result in it.
In psoriasis, the immune system is dysfunctional, triggering the skin cells to grow too fast. This causes the skin to become very thick, after which it falls off as scales.
Psoriasis is, however, not contagious, which means you cannot catch the disease from someone. It is not caused by not keeping clean, as is commonly believed.
As psoriasis is a chronic illness, patients need to constantly use creams and medication to keep the condition under control. This may entail repeated visits to a clinic for light therapy. The process can be long and frustrating.
‘When psoriasis first struck, I was very depressed and conscious of the curious stares I got,’ Mr Lim said. ‘At job interviews, I felt discriminated against because of my skin condition.’
Desperate for a cure, he visited traditional and religious healers and wasted thousands of dollars.
There are now many effective and proven therapies.
Dermatologists recommend, in addition to steroid ointments, creams which contain tar or vitamin D3. Phototherapy (light treatment) with ultraviolet light is also safe and effective in controlling the disease.
In severe cases, dermatologists might prescribe oral medication such as methotrexate, retinoids or cyclosporine.
Exciting new therapies called biologics have recently emerged. Like the proverbial magic bullet, biologics target specific parts of the immune system process that drives psoriasis. It can be particularly useful for patients who suffer from psoriatic arthritis (disease of the joints as a result of psoriasis).
Another psoriasis patient, Mr Tan, 49, had the disease attacking his spine. He was in constant pain and stiffness. His stooped frame made him look older than he was.
Since starting on monthly injections of biologics three months ago, he has found relief from the pain and has regained substantial mobility. While he is back to his active lifestyle, he always keeps to his medical appointments. His frail frame belies a truly tenacious spirit.
Recent scientific studies have linked psoriasis to chronic diseases like diabetes, high blood cholesterol and heart disease. Early and effective treatment of psoriasis not only protects skin and joints, but it may also reduce the risk of developing heart disease later.
When I saw Mr Lim again for his regular follow-up, he was beaming. His skin was clear; even the stubborn rash on his hands was gone. He whipped out a memoir – self-penned, type-written and ring-bound – on living with
It starts out as a simple but poignant account of suffering and humiliation, but ends with a story of faith and triumph.
He wrote: ‘As we patients live on with psoriasis, we will remember the kindness, concern and sympathy of those who looked after us.”
Dr Jean Ho is a consultant dermatologist with special interests in paediatric dermatology and laser surgery. She practises at Mount Elizabeth Medical Centre.