Topic 2: Diagnosis of Psoriasis

Welcome to DOC2US Psoriasis Health Tips Section. Hope you liked our previous article and let’s further discuss psoriasis today.

“It’s just a rash…What’s the hurry in seeking help?”

Why indeed?

Although it’s just a rash, we understand that it can be quite a stressful experience for those affected. Patients not only have to handle discomfort on a physical level such as pain, itching, but it can also take a toll on their mental health.¹ It’s quite frustrating to have people stare at your rashes when they speak to you and the shedding skin scales can really affect one’s self-esteem.

What’s more, psoriasis can develop into something called psoriatic arthritis, leading to pain and stiffness in the joints.² Studies have also shown that psoriasis increases the risk of cardiovascular diseases over time.¹

It may sound very terrifying with all these information, but do not worry as with early diagnosis and the right treatment, we can prevent the future development of vascular events.³ There are a wide variety of treatments that can help to relieve the symptoms you are experiencing, effectively and efficiently. Although psoriasis isn’t curable, it is treatable.

Let us look at a real-life example

A case report from the Medical Research Symposium 2019 reveals an 18-year-old girl who presented with psoriasis associated with numbness that persisted for 3 weeks.⁴ With accurate, early diagnosis and treatment using coal tar and topical corticosteroids, she no longer experienced any numbness with considerable improvements in her symptoms.⁴

Hence, psoriasis really isn’t as scary as it sounds.

Who should I seek help from?

Help is always just a step away. Step into the nearest clinic or pharmacy or opt for teleconsultation from the comfort of your home for an initial assessment. Your health professionals will be more than happy to assist you in any manner. Based on your condition, you may be referred to a dermatologist at any private hospital or state hospital.

Is teleconsultation possible with psoriasis?

Although the government has declared that Malaysia will begin transitioning into the endemic phase of COVID-19, you might still prefer meeting your physicians virtually rather than meeting them face- to-face and that’s perfectly understandable. Telemedicine plays a beneficial role for initial screening of your condition.⁵ Using images of your skin appearance, with or without a live video call, you can speak to a physician regardless of where you are, as long as you have a suitable device with stable Internet service.⁵  You may then proceed to see your physician if further investigations are required.

What’s next?

For initial assessment, your physician will conduct a physical examination and assess your plaque appearance, the number, location and severity of the lesions.^2,6

They will also assess the severity of your condition by determining the percentage of body surface area involved (BSA), your response to topical applications, the effect on your quality of life and signs of any physical disabilities or mental health condition.^6,7

Importantly, they will check for any symptoms of psoriatic arthritis, e.g. significant joint stiffness, joint swelling or inflammation of the finger or toe that can be painful.⁷

Most of the time, a physical assessment would be sufficient for physicians to diagnose psoriasis.

However, if further investigation is required, your physician may refer you to a dermatologist.⁷ Your dermatologist might perform a skin biopsy to rule out other conditions.⁷ On the other hand, if psoriatic arthritis is suspected, you may be referred to a rheumatologist.¹

In some cases, your physician may also require you to undergo some laboratory testing such as human leukocyte antigen (HLA) typing, bacterial culture, serologic studies for syphilis or microscopic (potassium hydroxide) exams if other conditions are suspected.⁶ This may sound very overwhelming but don’t you worry, you can always clarify with your physician if you have any doubts or concerns.

Some of the common assessment tools used include

• Psoriasis Area and Severity Index (PASI) which measures the severity depending on the redness, plaque thickness, scaling and the extent of body areas involved^1,6
• Physician's Global Assessment (PGA) measures psoriasis severity and response to treatment based on erythema (skin rash), induration (hardening) and scaling^1,6
• Body Surface Area (BSA) which measures the total area of your body affected by psoriasis⁸

• • Medications such as certain painkillers (e.g. NSAIDs), antibiotics (e.g. tetracycline), beta- blockers, lithium and antimalarial drugs (e.g. chloroquine, hydroxychloroquine, quinidine) can exacerbate psoriasis^6,9

5. Family and social history⁴
   • Genetic factors, smoking, high alcohol consumption and obesity are risk factors for psoriasis²

Have you read our previous article: Understanding Psoriasis? Click here to know more https://www.doc2us.com/topic-1-understanding-psoriasis 

Learn more about psoriasis in the next topic in this series – Treatment of Psoriasis.

A WORD FROM DOC2US

If you have any questions related to psoriasis, you can consult our professional doctors and healthcare professionals on DOC2US. DOC2US is a mobile application that allows you to talk to a doctor or any healthcare professional via text chat at any time and from anywhere. For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.Download DOC2US app on Apple App Store, Google Play Store and Huawei App Gallery; or use our webchat at https://web.doc2us.com/

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Disclaimer: As a service to our users and the general public, DOC2US provides health education content. Please note the date of the last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinicians

CP-304534 April 2022

References

5. Hickman R.J (2021). Telemedicine for Psoriasis-What You Need To Know -Verywell Health. Available at https://www.verywellhealth.com/telemedicine-for-psoriais-5078651 Website accessed: 8th March 2022
6. MIMS Dermatology. Psoriasis. Available at https://specialty.mims.com/psoriasis/diagnosis?channel=dermatology Website accessed: 11th January 2022
7. CPG Update. Malaysian Clinical Practice Guideline for the Management of Psoriasis Vulgaris: Summary of recommendations for management in primary healthcare setting. Available at https://e-mfp.org/wp-content/uploads/malaysian-clinical-practice-guideline-for-the-management-of-psoriasis-vulgaris.pdf Website accessed: 11th January 2022
8. Abayoma J. (2020). What’s Your Psoriasis Severity? - Healthline. Available at https://www.healthline.com/health/psoriasis/whats-your-psoriasis-severity#:~:text=BSA%20assessments%20measure%20the%20total,have%20moderate%20to%20severe%20psoriasis.Website accessed: 28th March 2022
9. Feldman S. (2019). Psoriasis: Epidemiology, clinical manifestations, and diagnosis - UpToDate (Table 1- Reported causes of psoriasiform drug eruptions). Available at https://www.uptodate.com/contents/image/print?imageKey=DERM%2F99889&topicKey=5664 &search=psoriasis&rank=2~150&source=see_linkWebsite accessed: 11th January 2022

Written by

Woong Yi Xin