Psoriasis....That's it

Flat, thickened coin-like and discoloured

This  48 year old lady patient  admitted she had been having treatment for her skin disease for several years in the private sector. From the history, I gathered that she had been shopping for doctors. When she first came to see me,  there was a patch of thickened,scaly and discoloured skin which looked like an allergic reaction which had been invaded by fungal infection on her left forearm. There were smaller coin-like lesions in her left foot, below the ankle and heel. They looked thickened and flat but scale-free with  darkened border.

Elevated,thickened with dark discolouration

She had come to the clinic and saw several doctors who prescribed an anti-allergic treatment, all of them had diagnosed it as an allergic dermatitis  and advised her not to take allergy-causing food such as egg, seafood and peanuts. Her condition, nevertheless, recurred unabated and persisted.

When she first came to see me, I also diagnosed it as an allergic skin condition mixed with a fungal infection and proceeded to treat her as such. she came back a month later and this time complained of intense itching and provided another information that the affected areas  were very  itchy especially after bathing.

Then she showed me newer crops of similar patches but this time on her right arm. She said that was how the big one started . I took one look at this newer lesion which was obviously not treated with all sorts of cream and oil like the earlier ones, meaning to say the appearance was in its natural state, it had not been altered by 'treatment' cream and the rest of the potion she had been applying all these years.

Newly erupted  red skin lesions with silvery scales

It was red and had silvery scales..yes, it was psoriasis, a chronic skin condition of unknown cause but seems to run in a family. When asked whether any other of her family members suffering from the same disorder, she denied.

Anyway, an appropriate treatment for psoriasis was initiated and she was advised that this skin disease was a persistent one, remitting and exacerbating. The treatment was only to relieve the symptoms, making her life more bearable with less itchiness. It may remit for a period, depending on an individual.

But for this kind of patient with low education, they find it hard to understand the concept of hereditary or chronic disease. Medically the disease requires continuous treatment. In this case, the use of emollient and specified solution known to reduce the eruptions and scaling of the upper layer of the skin. The characteristic of this lesion is that it can appear to heal for a long time and then it undergoes an  exacerbation. Unless a patient understand the nature of this skin condition, they will forever look for a cure and be stressed at the same time. Apparently stress  has been noted to worsen  the condition.

I asked her whether she had been overly stressed for the last few weeks ( to help explain for the newer lesions which I did not see four weeks earlier). Yes, she had been highly stressed having to look after her child who was hospitalised  for the last two weeks  following an accident.

As responsible doctors, we have to educate patient on the condition so that they are not bewildered by  its persistence. And that they would apply the standard treatment and not use hazardous cream and oil which could complicate  therapy.