Psoriasis - Challenges and Misconceptions - Q & A session with an expert.
(Focus - Malaysia)
The National Psoriasis Foundation (NPF) in the US observes August as Psoriasis awareness month, also referred to as "Psoriasis action month," which aims to educate the public about Psoriasis and enlighten patients on topics surrounding causes, triggers, and treatment methods. To provide more insights into the disease, we present our discussion with Dr. Benji Teoh Tze Yuen, a renowned dermatologist from Malaysia, who stated that education is a primary necessity to raise awareness.
Dr. Benji Teoh Tze Yuen is a Consultant Dermatologist currently serving in Park City Medical Centre (PMC), Malaysia.
Education is the way to go. But of course, the non-dermatologists may have a difficult time learning because they also have other things to learn. But ultimately, the way to move forward is through education.
We understand that misinterpretation of any chronic disease leads to mismanagement of patients. So, how common is the misdiagnosis of Psoriasis?
Dr. Benji: Misdiagnosis of psoriasis is not common among dermatologists, but in non-dermatologists such as other specialty or general practitioner, they may not be too familiar with psoriasis.
What do you think are the reasons for such type of misdiagnosis? What do you think can be done to prevent such misdiagnosis?
Dr. Benji: As a dermatologist, I am familiar with skin diseases. However, for non-dermatologists who are experts in other fields, they do not see skin diseases as frequently as we do as they too are busy with their own field. Education and awareness about psoriasis is the way to go to bridge the gap.
Is there anything else that can be implemented to prevent misdiagnosis and to make an accurate diagnosis of Psoriasis?
Dr. Benji: Education is the way to go. But of course, the non-dermatologists may have a difficult time learning because they also have other things to learn in their field. But ultimately, the only way to move forward is through education. Maybe in future, Artificial Intelligence can play a role.
As Psoriasis is associated with many other conditions ranging from psoriatic arthritis to psychological conditions, what are the challenges associated with treating psoriatic patients?
Financial challenges: Some of the better medications are relatively expensive, which leads to a financial burden.
Misconception about disease: There is a wrong belief, socially and culturally, in understanding the disease. They think that the condition is an allergic reaction or something to do with food. That part may be challenging, like people's mindset towards understanding the disease. And this situation may lead to a delay in the treatment.
Misunderstanding of the disease: Many are not aware or choose not to believe that this is a chronic disease with no cure in sight as of today. Many patients shop around looking to cure the disease and this leads to bad treatment outcome and patients being taken advantage of by people who are able to sell them hopes of a cure.
Low absorption of drugs topically and the potential toxicities can be listed as challenges for effective Psoriasis treatment . Do you foresee any interesting treatment options in the pipeline?
Dr. Benji: There are currently ongoing research on the use of topical JAK inhibitors that may be useful. Still, when all these medications come up, they are expected to be relatively expensive, and again, this will remain a challenge for many patients.
Is there any role of nanotechnology in treating Psoriasis patients?
Dr. Benji: Yes, possibly, because it may allow for better penetration of the drugs.
We understand that stress can trigger Psoriasis. Can you please tell me more about how stress and Psoriasis are interlinked?
Dr. Benji: Oh, that is a very good questions. I don’t think we know exactly 100% the interlink between stress and flare of psoriasis but I believe it is due to the release of glucocorticoids from our body when we are experiencing stress.
If they get Psoriasis, there is no risk reduction, but it can make patients feel better. When you have Psoriasis, your stress worsens the condition, or Psoriasis makes you depressed. But having psychological intervention does not mean that Psoriasis will be better.
Do you think having Psoriasis can make the patient depressed?
Dr. Benji: Yes, definitely.
In such cases, what psychological intervention can be used to minimize this risk of Psoriasis?
Dr. Benji: First, I think being educated on the disease is of utmost importance. I believe, once a patient has a better understanding of the disease, they would be able to cope with it much better with realistic expectations.
Apart from that, hypnosis and counselling are possible means to help with patients to cope with stress. I always believe stress is a perception, and within the same situation, different people will have different viewpoints about it. I always advise my patients to start learning to look at things from different angle, and that may possibly help them cope better with stress.
If a patient suffers from depressive episodes affecting their work and life, then I would refer them to a psychiatrist for further evaluation and treatment which is beyond my expertise.
Do you think implementing psychological intervention by psychiatrists reduced the risk of Psoriasis in your patients?
Dr. Benji: If they get Psoriasis, there is no risk reduction, but it can make patients feel better. When you have Psoriasis, your stress worsens the condition, or Psoriasis makes you depressed. But having psychological intervention does not mean that Psoriasis will be better.
We understand that Psoriasis cannot be cured entirely but can be managed instead. In this context, what will be your message to a psoriatic patient for effective disease management?
Dr. Benji: I always tell my patients that I cannot cure Psoriasis; there is no technology as of today to cure Psoriasis, but compare to yesteryears, we are doing much better. In the past, getting 75% improvement is an achievement, but today, our treatment target is aiming at 90%-100% skin improvement. That’s a big leap compare to just 20 years ago.
Before we close, would you like to share anything else with us regarding Psoriasis?
Dr. Benji: Psoriasis is a chronic disease, it is still incurable today, but very treatable. You are not alone when you have psoriasis. Talk to your dermatologists, and let's work together to get you a clear to near clear skin.
Thank you very much, doctor.