Psoriasis

Understanding Psoriasis

Psoriasis is a chronic autoimmune condition that affects the skin, leading to the rapid buildup of skin cells. This results in scaling on the skin’s surface and can cause redness and irritation. It is a common condition, with an estimated 2-3% of the global population affected. Psoriasis can appear at any age, though it often starts in early adulthood or between the ages of 15 and 35.

Symptoms

Psoriasis symptoms can vary in severity and may include:

• Plaques: Raised, red patches covered with a silvery-white scale are the hallmark of psoriasis. These plaques can appear on any part of the body but are commonly found on the scalp, elbows, knees, and lower back.
• Itching and burning: Affected areas may itch, burn, or feel sore.
• Dry, cracked Skin: Skin may become dry and cracked, sometimes bleeding.
• Nail changes: Psoriasis can affect the nails, leading to pitting, discoloration, or separation from the nail bed.
• Joint pain: In some cases, psoriasis is associated with psoriatic arthritis, which causes joint pain, stiffness, and swelling.

Causes

The exact cause of psoriasis is not fully understood, but it is believed to result from a combination of genetic and environmental factors:

• Genetics: A family history of psoriasis increases the risk. Several genes have been linked to the condition, influencing immune system function and skin cell turnover.
• Immune system: Psoriasis is an auto-inflammatory disorder which leads to excessive and rapid cell turnover and inflammation.
• Environmental triggers: Factors such as stress, infections, skin injuries, certain medications, and climate changes can trigger or exacerbate psoriasis flare-ups.

Diagnosis

Diagnosis of psoriasis typically involves a physical examination by a healthcare provider. The appearance and location of the skin lesions are usually sufficient for diagnosis. In some cases, a skin biopsy may be performed to confirm the diagnosis and rule out other conditions.

Treatment

Unfortunately, a cure for psoriasis is currently not available, but various treatments can help manage symptoms and reduce flare-ups:

• Topical treatments: Medications applied directly to the skin, such as corticosteroids, vitamin D analogs, and tar preparations, can reduce inflammation and scaling.
• Phototherapy: Exposure to ultraviolet light under medical supervision can help slow down the rapid skin cell growth seen in psoriasis.
• Systemic medications: Systemic drugs are frequently used for the control of moderate to severe psoriasis. These medications can be taken orally or via injection.
• Combination therapy: Sometimes, a combination of treatments is used to achieve better results.
• Biologics: In the last decades or more, biologics have radically improved psoriasis. By targeting the inflammatory pathways of psoriasis, e.g blocking interleukin-17 and/or interleukin-23, these monoclonal antibodies substantially clear psoriasis, helping patients to achieve complete or almost complete remission and substantially improving their quality of lives.
• Phosphodiesterase 4 (PDE4) inhibitor: For patients who could not tolerate immunosuppression or have other medical conditions like liver problems, PDE4 inhibitors has shown modest improvement for psoriasis.

Prognosis

Psoriasis is a long-term condition that tends to go through periods of flare-ups and remission. While it can be challenging to manage, most people with psoriasis can find relief through appropriate treatments and lifestyle adjustments. Ongoing care with a healthcare provider is crucial for effectively managing the condition and addressing any complications that arise.

Psoriasis impacts more than just the skin; it can also affect a person’s quality of life and mental health. Our expert dermatologists at Skin Physicians are equipped to give you the necessary support and treatment options to lessen the symptoms of the condition.

Nail disorders

There are many causes of nail abnormalities, ranging from fungal infections to malignancies. Laboratory investigations and biopsies may be necessary to determine the cause.

One of the more common nail problems is ingrown toe nail. At Skin Physicians, we perform surgical nail avulsions, partial nail avulsion, matricectomy for recalcitrant ingrown toe nails, and gutter splinting.

Mole check

We provide clinical and dermoscopic assessment of moles, together with skin biopsies and surgery for further evaluation and treatment.

If you notice any changes in size, shape, pattern, pigment changes to a pre-existing mole, or a newly developing pigmented lesion on the skin, a medical review is recommended.

Acne Scars

Pimple marks and scars can be left behind after inflammation of pimples. Red and brown marks tend to improve with time but the recovery can be hastened by skin lightening creams and chemical peels. Pimple scars can be protruding or depressed. Protuding scars include hypertrophic scars and keloids. They can be flattened by steroid injections into the scar tissue. Depressed scars can be improved by a variety of treatment options, including micro-peel laser and chemical peels for superficial scars, punch excision for pitted scars, subcision to loosen the skin fibres that tie the depressed scar down, and fractional carbon dioxide laser for controlled resurfacing of deeper scars. All these treatment options are specially provided by our practice, including the Smartxide DOT Fractional CO2 laser device, the leader in a new generation of fractional laser systems.

Hair Loss

Hair loss can be broadly categorised into non-scarring and scarring alopecia.

The common causes of non-scarring hair loss are male/female pattern hair loss, alopecia areata and telogen effluvium. Scarring hair loss is less common, but early recognition and diagnosis is important because once it has occurred the hair loss is permanent. Therefore it is crucial to start treatment early. A scalp biopsy may be necessary to confirm the diagnosis.

At Skin Physicians, we provide a comprehensive range of treatment options for these hair loss problems ranging from topical/oral medications to injections. In addition, we have available diphencyprone immunotherapy for extensive or refractory alopecia areata.

Eczema

Understanding Eczema

Eczema, also known as atopic dermatitis, is a chronic skin condition characterised by inflammation, redness, and irritation. It affects millions of people worldwide and can occur at any age, though it often begins in childhood. The condition is marked by flare-ups that can vary in severity and often become less severe with age, though some individuals continue to experience symptoms throughout their lives.

Symptoms

The primary symptoms of eczema include:

• Itchiness: This is often the most distressing symptom, leading to significant discomfort and disruption to daily life.
• Redness, inflammation: Affected areas can appear red and swollen, particularly in lighter-skinned individuals. In darker skin tones, the skin may look darker or ashy.
• Dry, scaly patches: The skin often becomes dry and flaky, which can lead to cracking and bleeding.
• Blisters: In some cases, small, fluid-filled blisters may develop.
• Thickened skin: Repeated scratching can cause the skin to thicken and become leathery, a condition known as lichenification.

Causes

Eczema is thought to result from a combination of genetic and environmental factors:

• Genetics: A family history of eczema, asthma, or hay fever increases the likelihood of developing the condition.
• Immune system: Eczema is associated with an overactive immune response, which leads to inflammation and skin damage.
• Environmental triggers: Common triggers include allergens (like pet dander or pollen), irritants (such as soaps or detergents), temperature extremes, and stress.
• Skin barrier dysfunction: A compromised skin barrier allows moisture to escape and irritants to enter, exacerbating the condition.

Diagnosis

Diagnosis of eczema is typically based on medical history and a physical examination. The patient’s family history, symptom patterns, and any potential triggers may be asked by dermatologists. In some cases, patch testing or other diagnostic tools may be used to identify specific allergens or irritants.

Treatment

Treatment for eczema aims to alleviate symptoms, prevent flare-ups, and improve the overall quality of life. It usually involves a combination of:

• Moisturisers: Regular use of emollients helps to keep the skin hydrated and protect the skin barrier.
• Topical steroids: These anti-inflammatory medications reduce swelling and itching. They should be used as prescribed by a healthcare provider to minimize side effects.
• Topical calcineurin inhibitors: These non-steroidal medications can be used for sensitive areas and long-term management.
• Antihistamines: Oral antihistamines may be prescribed to help control itching, especially if it disrupts sleep.
• Avoiding triggers: Identifying and avoiding known irritants or allergens is crucial for managing eczema effectively.
• Phototherapy: For severe cases, light therapy (exposure to ultraviolet light) may be recommended.
• Biologics: In recent years, non-steroid treatment using monoclonal antibodies has been very effective in reducing itch and rash of severe atopic dermatitis. Biologics have been a game-changer for severe atopic dermatitis, especially for patients who have been on long term oral steroids and immunosuppressive drugs.
• Janus Kinase (JAK) Inhibitors: This new class of drugs which block the intracellular signalling of inflammation have also been shown to effectively reduce itch and rash in severe atopic dermatitis. Some of these drugs have received FDA approval for this purpose. Before starting on oral JAK inhibitors, certain blood tests need to be performed including that to exclude tuberculosis. Regular blood testing is also needed for patients on this class of medications. Recently a prescription topical cream has also been approved by FDA for topical treatment of atopic dermatitis.

Prognosis

While eczema is a chronic condition, many people find that their symptoms improve with age or with appropriate management strategies. Regular follow-ups with a healthcare provider can help tailor treatments to individual needs and address any emerging issues.

Managing eczema requires a comprehensive approach that includes medical treatment, lifestyle adjustments, and ongoing care. At Skin Physicians, our dedicated dermatologists will use the right strategies to help make your eczema a little more manageable.

Acne

We offer a comprehensive range of treatments which aim to clear, control and prevent pimples. The programmes include the use of oral medications, topical creams, chemical peels, laser micropeels and non-invasive blue light therapy. (Acne scars)