Dr Peter Ch’ng Wee Beng  Consultant Dermatologist, Peter Skin Specialist, Gleneagles Kuala Lumpur

Five things about psoriasis

1. Psoriasis is not simply a skin disease. It is an auto-immune disease, which arises when something goes wrong with the immune system. People with this condition have raised red, scaly patches (or plaques) on their skin.
2. About 1-3% of Malaysians are affected, and psoriasis can affect both adults and children of both sexes.1
3. About 30% of people with psoriasis will develop psoriatic arthritis, a condition that can cause joint pain, stiffness and swelling. Movement becomes difficult and often painful, and joint deformities may arise.2
4. There are long-term effects on the health. In addition to psoriatic arthritis, untreated psoriasis is also linked to increased risk of diabetes, obesity, cardiovascular disease and stroke. Young people with psoriasis, especially more severe psoriasis, are at higher risk of having reduced life span.
5. One cannot catch psoriasis from other people.

Thus, if psoriasis affects you or your loved one, it is important to get proper medical attention and treatment as early as possible.

The Burning Itch

1. Up to 90% of people with psoriasis can experience itch as a constant frustration in their lives.3 This itch is a burning and sometimes painful sensation, comparable to bites of fire ants.
2. Itch can be triggered by stress, so yoga, meditation and other relaxation therapies can be useful. Regular exercise and counseling can also help.

A blow to the self-esteem

• Psoriasis can affect a person’s ability to socialize, form romantic relationships and find employment. This leaves him or her vulnerable to depression and destructive behaviour such as drug abuse and alcoholism.
• A published review in the American Journal of Clinical Dermatology suggested that “social stigmatization, high stress levels, physical limitations, depression, employment problems and other psychosocial co-morbidities experienced by patients with psoriasis are not always proportional to, or predicted by, other measurements of disease severity such as body surface area involvement or plaque severity”.4  Thus, the severity of psoriasis will not be made based only on physical examination. The dermatologist will also evaluate the impact of the condition on your quality of life.

Treatments for clearer skin

There are a number of treatment options available for psoriasis. It is not unusual for the dermatologist to change to a different treatment if a patient is not responding adequately to his or her current treatment.

Topical treatments.

These are the creams, ointments and lotions that can be applied onto the affected areas of the skin.

• Those containing ‘peeling agents’ such as salicylic acid help to soften psoriasis scales, making them easier to remove.
• Moisturizers are important to prevent dry skin, which tends to be itchy and may worsen psoriasis.

Light therapy (phototherapy).

Ultraviolet light B (UVB) is targeted at affected areas to slow the growth of skin at the affected areas. This is an effective treatment, but the patient needs to receive it consistently for best results.

Medications.

Methotrexate is a commonly prescribed medication: it has been found to be effective for many patients and the number of patients that experience side effects is relatively small. It is also a cost-effective medication. Aside from methotrexate, cyclosporine and retinoids are also some examples of more conventional medications.

Recently, another type of medication, called biologics, has been developed. Biologics are bioengineered medications that target specific pathways in the immune system. Because psoriasis is a condition caused by abnormal workings in the immune system, biologics can be a more effective, accurate form of treatment. Some examples are etanercept, infliximab, adalimumab and ustekinumab. Biologics are usually injected into the skin or administered intravenously (through a drip).

New medication offers better hope for clear skin

Secukinumabis a biologics that binds specifically to a protein in the body called interleukin-17A (IL-17A), stopping its activity and reducing symptoms very effectively.5

• 8 out of 10 patients achieved clear or almost clear skin with 90% skin clearance (PASI 90).6
• 83% of patients achieved 75% skin clearance (PASI 75) after three years.7
• Clinical trials on more than 4,000 patients found that its safety profile is similar to other biologics in the market.8

References:

Haq, A.S.M. (2014). Medication Therapy Adherence Clinic for Psoriasis Patients: A Malaysian Initiative: Symposium for Senior Pharmaceutical Policy Makers. Kuala Lumpur: Ministry of Health Malaysia.

Gladman, D., et al. (2005). Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis.; 64(Suppl 2): ii14–ii17.

National Psoriasis Foundation. Managing itch. Retrieved on August 4, 2016 from https://www.psoriasis.org/life-with-psoriasis/managing-itch

Kimball, A.B., et al. (2005). The psychosocial burden of psoriasis. Am J Clin Dermatol.;6(6):383-92.

Novartis International AG. (2015). Novartis announces FDA approval for first IL-17A antagonist Cosentyx(TM) (secukinumab) for moderate-to-severe plaque psoriasis patients. Retrieved on Aug 3, 2016 from https://www.novartis.com/news/media-releases/novartis-announces-fda-approval-first-il-17a-antagonist-cosentyxtm-secukinumab

Thaçi D., et al. (2015). Secukinumab is superior to ustekinumab in clearing skin of subjects with moderate to severe plaque psoriasis: CLEAR, a randomized controlled trial. J Am Acad Dermatol;73(3):400-9.

Novartis International AG. (2015). Novartis presents new data showing that the majority of patients are able to maintain clear or almost clear skin with Cosentyx across 3 years. Retrieved on Aug 3, 2016 from https://www.novartis.com/news/media-releases/novartis-presents-new-data-showing-majority-patients-are-able-maintain-clear-or

 PI RD 09 DEC 2015; APPR 28 APR 2016

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