From Heartbreak to Hope
New treatments are transforming the lives of psoriasis patients
Living in a tropical climate, Singaporeans like to slip into their shorts and t-shirts to enjoy the sunshine or the cool evening breeze on their skin. But for Singaporeans with psoriasis, few feel confident to enjoy the simple luxury of wearing short, sleeveless clothes. For them, each day is a battle to keep their skin hidden, their physical discomfort disguised, and their emotional torment under wraps. This is the heartbreak of psoriasis.
Psoriasis is an incurable condition that affects people from all walks of life and every social demographic. Between one and three percent of Singaporeans are believed to have the disease. Yet despite its prevalence, it is a skin disease that is largely misunderstood by the general public.
More than just skin deep
Psoriasis occurs when faulty signals in the immune system cause skin cells to grow too quickly – every three to four days instead of the usual 30-day cycle. Extra cells build up on the skin’s surface, forming red, flaky and scaly patches that are often itchy and uncomfortable. Psoriasis is highly visible and can appear anywhere on the body, most commonly on the joints, limbs and scalp.
For sufferers, simple activities such as using their hands, walking and other physical activities can become troublesome as the pain and itching can interfere with their daily routines.
However, to assume that sufferers only have the weight of a physical burden to contend with is to underestimate the impact of psoriasis entirely. The effects of psoriasis are more than just skin deep. Relationships and intimacy can be difficult. Imagine finally plucking up the courage to ask someone for a date and then out of the blue you suffer a ‘flare up’ of psoriasis on your scalp or arms. Added to the first date nerves is the fear of how the other person will react.
Even patients in long-term relationships whose partners are fully aware of their condition may be plagued with self doubt and a lack of confidence. Many are embarrassed to let their partners see them naked or touch their skin.
Dealing with psoriasis
Living with someone who has this chronic condition can also be challenging. For family members, it can also be difficult to watch a loved one struggling to come to terms with their psoriasis. If you are a parent of a teenager, you can understand how a simple shopping trip can turn into a traumatic experience. For most of us, a little retail therapy works wonders. But for teenagers with psoriasis simply buying clothes can be difficult. While their friends are sporting the latest fashions, short dresses and sleeveless tops, they can only look wistfully on while heading over to the long sleeved tops and jeans sections.
Psoriasis can also be a challenge in the workplace. A recent study of Singapore patients found seven percent of psoriasis sufferers were unemployed as a direct result of their condition, making it impossible for them to hold down a job – a rate which is more than three times higher than the unemployment rate for the rest of Singapore. You might feel failing to go to work means you are failing to support your family. It is little wonder then that sufferers often feel helpless, angry, frustrated and depressed due to the appearance of their skin. Some even admit to experiencing thoughts of suicide.
New treatment on the block
While psoriasis can be the cause of great heartbreak, there is a range of treatments available, including creams and ointments, phototherapy, systemic and biologic therapies. Some patients may develop resistance to certain treatments after prolonged use, and psoriasis can behave differently depending on the individual. But patients should not be deterred just because one treatment hasn’t produced the desired result. It doesn’t mean another treatment option won’t.
In recent years, advances in medicine have brought about a new breakthrough treatment called biologics, which are offering hope to many Singaporeans struggling with this disease. The new kid on the block is a biologic called ustekinumab. Biologics, unlike other treatments are made from living human or animal proteins and work by blocking the action of certain immune cells (T-Cells) or the chemical released by them, which play a part in causing psoriasis.
Almost all treatments that work for psoriasis and psoriatic arthritis impact or target the immune system in some way. This is true for ultraviolet (UV) treatment and some systemic medications as well. The difference is that their impact on the body is broad, while biologics are more targeted.
Ustekinumab is the first of a new type of biologic for moderate to severe psoriasis that combines powerful psoriasis relief with very infrequent or convenient dosing. Improvements in the patient’s condition can be dramatic. After just 12 weeks, approximately 75 percent of patients in a trial saw at least 75 percent improvement in their skin psoriasis symptoms, and the improvement was sustained by most for periods up to four years.
Administered by injection into the fatty tissues, patients receive two initial doses four weeks apart and then maintenance doses every twelve weeks thereafter. Currently, ustekinumab can only be administered by a health care provider in a doctor’s office.
No one can deny the heartbreak that accompanies an incurable condition like psoriasis. However, new medications can offer both physical and emotional freedom to psoriasis patients who had previously given up hope.