SGH shared about some of the risks linked to psoriasis as well as recommended lifestyle changes for patients.
Original title: Challenges of living with psoriasis
Patients with psoriasis often also have to deal with the reaction of strangers
Madam Siti Fatimah Buang often gets stares when she goes out.
At work, the 38-year-old administrative officer covers up as much of her skin as possible so colleagues would not pass remarks about her.
Like many patients with chronic inflammatory skin diseases, Madam Siti, who has psoriasis, has had to deal with not only the condition but also the reactions of people around her.
She said: "When you have a skin problem, people often just assume that it's because you don't have proper hygiene, and they judge you when you go out in public."
Madam Siti was first diagnosed at the age of 19 with psoriasis, characterised by pink or red plaques with silvery-white scales usually over the scalp, ears, elbow, knees and trunk.
"It also affects the nails and the joints, causing nail deformities and arthritis," said Dr Tan Siew Kiang, a specialist in dermatology, and consultant at Raffles Skin and Aesthetics.
Initially, only Madam Siti's scalp was affected. "It feels very embarrassing, especially when I go to hair salons as the hairdressers think I have dandruff and I do not wash my hair properly," she said.
She wears a hair net when she cooks to prevent the scales from getting into the food. From her scalp, her psoriasis has spread to the rest of her body.
Last December, Madam Siti was diagnosed with psoriatic arthritis, a condition where a person's joints become stiff, red, painful and swollen. She found herself unable to carry heavy things as she had no energy in her limbs.
She said: "I wasn't able to do simple things like cooking, cutting or drying clothes as my limbs would get tired easily. As a mother and a wife, these are some things I want to do for my family but am unable to. I feel angry with myself because I feel useless."
Madam Siti has to take about 30 tablets a week to treat her psoriasis and psoriatic arthritis.
Thankfully, her family is very supportive and helps her with the household chores whenever she is too tired to do them. To help others like herself, Madam Siti joined the Psoriasis Association of Singapore last year.
She said: "I want to tell others like me who have psoriasis that it is not a disability. Don't restrict yourself just because you have psoriasis, go and enjoy time with your family. Don't care about what others say about you, just go on and don't feel pressured or judged."
More than just a skin disorder, psoriasis has other health implications. "Patients with psoriasis have a higher risk of metabolic diseases like hypertension, hyperlipidaemia, obesity and diabetes and cardiovascular disease," said Dr Hazel Oon, senior consultant dermatologist at the National Skin Centre.
Studies show that patients with moderate to severe psoriasis have about a twofold increased risk of metabolic diseases than the general population, and the risk rises with the severity of the psoriasis, said Dr Yeo Yi Wei, consultant at the Department of Dermatology, Singapore General Hospital.
While the exact cause is not known, "it has been proposed that extensive inflammation in the skin in psoriasis may also reflect inflammation internally and inflammation of the blood vessels of the heart", said Dr Yeo. Doctors The Straits Times spoke to encouraged patients with psoriasis to adopt a healthy lifestyle and go for regular medical check-ups.
"Lifestyle modifications such as maintaining a healthy weight and diet, exercising regularly, quitting smoking and avoiding excessive alcohol intake can be beneficial in reducing the risk of metabolic syndrome and its complications," said Dr Yeo. "Annual screening for metabolic syndrome should be encouraged in those with moderate to severe psoriasis so that it can be picked up early and treated before it becomes a problem."
Mr Tan Lai Heng, 55, a psoriasis patient of 18 years, has other metabolic diseases such as hypertension, diabetes and high cholesterol due to the skin disease.
"I have so many different conditions but I try not to think about it as I don't want to be depressed. I try to remain positive despite the many adversities that I face," said Mr Tan, who is unemployed.
To keep himself healthy, he exercises two to three times a week. "When I found out I had psoriasis, I had no idea what it was. My skin was red and itchy and I couldn't sleep at night," said Mr Tan.
He added that doctors have told him he had an increased chance of getting other metabolic diseases.
Due to his condition, Mr Tan has to go for check-ups once every three months."I think having to go for so many check-ups is really very inconvenient but I have no choice. I have to go and get treated so that I can get better," he said.
Like Madam Siti, Mr Tan has also had people make insensitive comments about his condition. "I was angry and upset because psoriasis isn't infectious, it's just a skin condition," said Mr Tan, who is also a member of the Psoriasis Association of Singapore.
"I hope other psoriasis patients like me will get better. I want to encourage them to persevere and never give up on themselves."
Psoriasis often mistaken for eczema
Psoriasis is commonly mistaken for eczema, another skin condition.
"In Singapore, it is estimated that at least 40,000 persons are affected with psoriasis," said Dr Nisha Suyien Chandran, head and consultant at the division of dermatology in National University Hospital.
Dr Tan Ki Wei, consultant at
Changi General Hospital's ( dermatology department, said psoriasis is sometimes mistaken for eczema as both can result in a dry, itchy and scaly rash. "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," he added.
Both conditions affect patients physically and psychologically. Apart from the itch, they have to deal with the appearance of their condition to others.
"It has been reported that up to 89 per cent of psoriatic patients feel shame and embarrassment over their appearance, with 42 per cent suffering from a lack of confidence," said Dr Yeo Yi Wei, consultant at the department of dermatology in Singapore General Hospital.
Doctors say psoriasis is caused by genetics and environmental factors.
"Some people are more likely to develop psoriasis, particularly if there is a family history of psoriasis," said Dr Tan Siew Kiang, specialist in dermatology, and consultant at Raffles Skin and Aesthetics.
"For many patients, factors such as infections, stress, alcohol and smoking have a role, triggering flares of psoriasis." There is no permanent cure, but there are treatments. Dr Tan Ki Wei said treatments include use of moisturisers, steroid creams, Vitamin D analogue creams, oral immune suppressants, the injection of biologic drugs and phototherapy, a treatment using light.
Dr Chandran said: "It can be effectively managed. Lifestyle measures such as moisturising, quitting smoking, reduction or avoidance of alcohol, and managing stress may help."