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MESSAGES TO
Psoriasis

Psoriasis

A DxD Session with Dr Colin Theng


Ended on Sun Jul 21 2019
Ended

Top Answers


Hi, thanks for the D2D.

Genes play a very important role in the development of Psoriasis. If you have a family history of psoriasis, you will have an increased risk of developing psoriasis. The development of psoriasis depends on an interplay of genetic and environmental factors. Psoriasis does not start at birth but often later in life, with the peak age of onset in the late teens are the twenties. You can develop childhood psoriasis though this is a less common presentation.  If one parent has psoriasis, the risk of developing psoriasis is about 20%.  If both parents your parents have psoriasis, the risk can go up to about 50%.

At 23, you have not developed psoriasis, so that is great.  Your risk of developing psoriasis is definitely higher than someone who does not have a family history of psoriasis, but it is not invariable that you will develop psoriasis. There is a greater chance that you will not develop psoriasis, so stay positive.

4 Nov 2018

Eczema is much more common in childhood compared with psoriasis. The inner elbow area or flexural area is also a more common site for atopic eczema. Psoriasis tends to affect more the extensors of the elbow and the onset is often in the later teens and twenties, although it can also occur in childhood.

The diagnosis of psoriasis and eczema is usually made clinically. If you have any doubts, you can visit your doctor or dermatologist, who can give you a proper assessment of the rash.

4 Nov 2018

I’m going to keep a food diary to keep track of my psoriasis. I’d like to know how I can tell which foods will trigger my psoriasis – is there a delay between eating something and the onset? Will I know immediately if a certain food has set off psoriasis?

The link between psoriasis and diet is not strong. I do advise people with psoriasis to refrain from too much alcohol and smoking as these may aggravate psoriasis.

As for diets, psoriasis is not linked conclusively to any foods and there are no usual recommended diets for psoriasis. Keeping a food diary may be more relevant for eczema, which may be food related or triggered in some cases.

I do encourage eating healthily as individuals with psoriasis have a higher risk of being overweight and developing diabetes and high cholesterol. Psoriasis is not due to food allergies.

There have been some small studies to suggest that fish oils may be helpful and low gluten diet may be beneficial but the evidence is not robust.

4 Nov 2018

Hello Gary,

Thanks for the D2D. 

Firstly, I think it is important to try to lead a healthy and stress-free lifestyle. Stress is hard to avoid in stressful Singapore but it is a well-know trigger of psoriasis, so do not forget to minimize stress in your life.

For mild psoriasis, this is usually treated with topical medications. Topical steroids, coal tar and vitamin D analogues creams are commonly prescribed. They are effective for controlling psoriasis when there is a limited area of involvement.

If your psoriasis is more extensive, it can be difficult to apply the creams as it can be time consuming and messy, and often the adherence to treatment is low.

Phototherapy is good treatment option if your psoriasis is more extensive or if you fail topical treatment. This involves the use of ultraviolet light and it is like going for a medical tanning session in a light booth, but you have to attend treatment 2 to 3 times a week.

In severe cases of psoriasis, oral medications like methotrexate, acitretin and cyclosporine can also be used. These medications are effective in treating psoriasis, although they do suppress the immune system and affect the liver, kidneys and blood counts. However, with careful monitoring, they can be used safely to treat psoriasis.

There are now new treatments for psoriasis which are highly effective. These are the biologic  agents and they are given by injections.  They have been developed through advances in biotechnology and target specific immune pathways that cause psoriasis. They have changed the landscape of psoriasis treatment with the latest biologics achieving clear or almost clear in up to 80% of patients. I have many patients who were once covered in psoriasis, having failed all the traditional treatments, who are now completely clear of psoriasis. The biologic agents  do suppress the immune system but have minimal impact on the liver and kidneys, unlike the traditional oral therapies.

4 Nov 2018

Hello Jason,

Thanks for the D2D.Psoriasis is indeed a chronic disease and you are right that you can expect to be on treatment for some time.

The price of topical creams can vary depending on the type of creams used and the amount used. Topical coal tar and topical steroids are generally less expensive that the vitamin analogues.

The cost of oral medications also vary depending on the medication prescribed. Methotrexate is most cost-effective treatment and cyclosporine a most expensive treatment. The price can range from $30 to 600 dollars a month.

The new biologic agents, while highly effective, come with a hefty price tag. The cost can range from $1200 to 2000k a month depending on the biologic that is used. 

4 Nov 2018

Hello Coco,

Thanks for the D2D. You are right that sunlight and UV therapy can indeed help to relieve psoriasis.  You may have heard about dead sea treatment where people spend a few weeks lazing in the dead sea to treat their psoriasis. It is believed that it is the ultraviolet from the sun that helps in a large part to the improvement in psoriasis.

UV therapy is employed as part of medical treatment for psoriasis.  You will require 2 or 3 treatments a week. There is a small increase risk of skin cancer with the treatment and generally, we not treat beyond 200 to 250 treatment sessions.

Natural sunlight is helpful but it is important not do develop a sunburn as this can aggravate and trigger psoriasis.  10 to 15mins in morning sun is probably a safe to avoid a sunburn.  The skin damage from sun exposure is also cumulative, so the more often you do it, the more damage there is to the sun.

4 Nov 2018

Hi, thanks for the D2D. Phototherapy is an effective treatment for psoriasis and currently, narrow band UVB is the main UV therapy used. NBUVB is UVB in the 311 to 313nm wavelength. This wavelength is an efficienct wavelength for the treatment of psoriasis.

Natural sunlight has a very broad spectrum wavelength, so while it does carry the therapeutic wavelengths, it also has other wavelengths that can cause more burns and skin damage.

So overall, medical UV therapy is better than natural sunlight in treating psoriasis.

4 Nov 2018

Hello Yang,

Thanks for the D2D. 

Heat and sweat can make a person feel more itchy. With psoriasis, your skin may be more sensitive to extremes of temperature. However, this is not true of all people with psoriasis  and many are able to continue to exercise and lead a healthy lifestyle. In fact,  psoriasis has been linked with an increase risk of heart disease, obesity, diabetes and hypertension. It is therefore  important to exercise regular and maintain a healthy lifestyle.

It minimize the redness and itch, you can try exercising in a cooler environment and avoid exercising between 10 am to 4pm when the sun is at the hottest. Wearing loose fitting clothing and try to wipe dry frequently. You can have cool shower immediately after the exercise and remember to moisturizer immediately after showering to keep the skin well moisturized.

4 Nov 2018

Hi, thanks for the D2D. 

This is a great question. From published data, there may be a slight increase risk of developing cancers in Individuals with psoriasis. Some studies do show a possible increase risk of  cancers like lymphoma, lung cancer and skin cancer.  Possible reason for this includes the chronic inflammation and impaired immune-surveillance in psoriasis individuals.

The treatments used in psoriasis may also lead to an increase in the risk of cancers eg phototherapy can lead to increase in skin cancers and the oral and systemic treatments like cyclosporine may also increase the risk.

Overall though, the increase in cancer risks is small, so you should not be overly worried by the findings. As you have pointed out, some studies did not find significant increase risks of cancer.

4 Nov 2018

Hi, thanks for the D2D. Currently, despite the many advances in the treatment of psoriasis, we still do not have a cure for psoriasis. You do not ‘outgrow’ your psoriasis. It is also difficult to predict your pattern of psoriasis. Majority of people will have mild psoriasis, but about 20%  of people may have moderate to severe psoriasis.

Your will find that your psoriasis often fluctuates in severity. There are periods where the skin may be flaring and other times when it may be calm and sometimes even completely clear. I have seen people whose psoriasis has seemingly vanished for over 10 years, only to reappear years later. 

So while we do not outgrown psoriasis, we can be hopeful that it goes into a period of quiet for some time.

4 Nov 2018