Does size matter?

The Doctor Says
By DR MILTON LUM

Concerns about the size of genital organs are often unwarranted.

MOST humans are concerned about the size of objects. For many, big is beautiful up to a point after which, it may become ugly. For others, small is beautiful again up to a point after which, it becomes unacceptable. Only a few of us have no views on size.

As it is with inanimate objects, so it is with the human body. Many adults are concerned about the size of their genital organs, particularly its relationship to sexual performance and satisfaction.

The paucity of information in the public domain, the gaps in consumers’ medical knowledge, misinformation and advertisements in the print and electronic media and the reluctance of many doctors and health care professionals in discussing such matters have contributed to misperceptions.

Men’s size

The male is fascinated with the penis from an early age. As boys become adults, many become convinced that it would be better if the penis is just a bit longer. Information from friends and advertisements reinforce the perception that there is a relationship between penile length and manhood.

Most females cannot understand this fascination or obsession. There are reports that chance remarks about small penile size, particularly in the bedroom, have led to impotence (erectile dysfunction).

When a male sees his penis, it is at an angle, which makes it appear to be shorter than it really is. But when he sees another male’s penis, there is no such foreshortening effect, so it appears that the other’s penis is longer.

One should remember the facts about penile size. Wessells and his colleagues reviewed publications on penile length in 1996. The average length of a flaccid penis, measured from the base to the tip, is 8.85 to 10.7cm while that of an erect penis is 12.89 to 15.5cm. During an erection, the shorter flaccid penile length of a male will increase more than that of another with a longer flaccid length.

It should be remembered that the vagina can accommodate any penile size as it is distensible because of its capacity to increase in length if an object is introduced gradually. There is no relationship between race, height and penile size. Neither is there a relationship between penile size and sexual performance and satisfaction. Some men have bigger penises than others, just as some men are taller or of bigger build than others but penile size is no indicator of virility.

Concerns about sizes

If one is unhappy about his penis size, it is advisable to consult a general practitioner or urologist. In most instances, reassurance that the penis size is normal is all that is necessary.

Many people advertise their claims of methods of increasing penis size. The expert opinions on the methods are:

• Pills or patches – a complete waste of time
• Penile enlargement exercises – probably futile
• Penile suction devices – probably of little use
• Penile enlargement surgery – uncertain value with risk of bleeding, infections and deformity.

Surgery may lead to the flaccid penis appearing longer but it makes no difference to the size at erection. There are reports of some modest improvement in length with penis stretchers (expanders). Some men may want to reduce the penis size. Although this can be done, there are risks of bleeding, infection and deformity. A urologist should always be consulted prior to the use of devices or surgery.

Female size

The vulva is the visible part of the female genital organs. It includes the clitoris, labia and urethral opening. It is not uncommon for women to be concerned about the size of their vulva and vagina as it plays a major role in their sexuality. A common myth is that a large vagina is associated with excess sex. This is incorrect as the frequency of sex has no impact on vulval and/or vaginal size.

Braun and Kitzinger in their publication Culture, Health and Sexuality put it succinctly: “With the construction of women’s genitals as problematic, the ‘private’ female body becomes a site for potential improvement. Socio-cultural accounts of vaginal size in the West construct a tight (but not too tight) vagina as desirable, and a ‘loose’ vagina as undesirable. In women talk, we found a curious pattern: women identified the cultural desirability of a tight vagina, and noted negative uses to which this is put (such as the positioning of women with ‘loose’ vaginas as promiscuous).

“However, when women described their personal concerns about vaginal size, these were couched in terms of anxiety about being too tight. We argue that constructions of vaginal size are problematic because they create another site of bodily concern for women, and are used to control and abuse women. We suggest that they also reflect a disregard of women’s sexual pleasure, and a lack of familiarity with the functions of the vagina.”

Weber and his colleagues studied the relation of vaginal anatomy to sexual function and concluded: “Vaginal anatomy measured by introital calibre, length and vulvo-vaginal atrophy does not correlate well with sexual function, particularly symptoms of dyspareunia (painful intercourse) and vaginal dryness.”

If a woman has not given birth, there is no way that her vulva or vagina is too big. However, childbirth affects vulval and vaginal size. The more babies delivered vaginally, the more likely the size will be increased. This is because the vaginal muscles and its supporting tissues are damaged during childbirth, particularly when labour is prolonged or difficult.

The increase in vulval and vaginal size can be prevented by adherence to pelvic floor exercises for six months after delivery. This involves tightening up the pelvic floor muscles, like trying to stop passing urine, holding the contraction for 10 to 15 seconds, relaxing for 10 to 15 seconds, repeating the contracting and relaxing for five to 10 minutes and doing the exercises three to four times a day.

Too big

The effects of too big a vagina include less than satisfactory vaginal intercourse for the female and/or male, air and/or water getting into the vagina and descent (prolapse) of the vagina, uterus and other pelvic organs in later life.

There are different treatment methods. Intensive pelvic floor exercises described above for six months will lead to improvement. Working at vaginal muscle developers for some time can also improve matters. A pelvic floor repair done by a gynaecologist brings together and tightens the weakened pelvic floor muscles and tissues.

Many women are concerned that the vulval lips (labia) are too large, too long or protrude unequally. If there are such concerns, a gynaecological consultation will be helpful. In most instances, reassurance that one is normal is all that is necessary. If there is a genuine abnormality, it can be corrected surgically.

Sometimes, a female may feel that her vulva and vagina are too small. They are statistically very rarely correct. A small vulva and vagina may be the result of surgery to the vulva and vagina. Too small a vagina can occur when there is a vaginal septum, which may lead to a double barrel-shaped vagina. The symptoms include inability to insert a tampon, pain on vaginal intercourse or total inability to have intercourse.

The vast majority of women with these symptoms have a normal sized vagina. However, many of them suffer from sustained contraction of the vaginal muscles whenever there is an approach to the genital organs (vaginismus). An internal examination will provide the answer to questions about smallness. A vaginal septum is easily treated surgically. The treatment of vaginismus is challenging and requires an expenditure of time and effort by both patient and doctor. If the vulva and vagina are genuinely small, it can be corrected surgically.

Whenever there are concerns about the size of the genital organs, it is advisable to consult a doctor. To do otherwise is risky and to have an untrained person do the job is to court disaster.

• Dr Milton Lum is chairperson of the Commonwealth Medical Trust. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

Belajar kenali payu dara sendiri

Oleh ROSMAWATI MION

BARAH payu dara merupakan barah paling kerap berlaku di kalangan wanita seluruh dunia dan dikenalpasti sebagai pembunuh utama kaum Hawa.

Di Malaysia, Laporan Daftar Kanser Kebangsaan turut menyebut setiap satu daripada 19 wanita berisiko menghidap barah payu dara sepanjang hidupnya.

Masalahnya, meski wanita dibelenggu rasa bimbang, khuatir dan takut akan penyakit itu, hairannya masih ramai tidak mengambil kisah tentang pemeriksaan awal payu dara.

Itulah juga yang ditekankan Pakar Perunding Bedah Payu Dara, Pusat Perubatan Pantai (PMC) Bangsar, Dr. M. Devanand, dengan memberitahu, kebanyakan wanita tidak menjadikan pemeriksaan payu dara sebagai satu perkara wajib yang perlu dilakukan.

Malah katanya, sesetengah wanita tidak akan pergi ke hospital atau klinik untuk menjalani pemeriksaan selagi mereka tidak merasai ketulan atau kelainan pada payu dara mereka.

‘‘Sedangkan, pemeriksaan sendiri payu dara (PSPD) sepatutnya dilakukan setiap bulan. Ujian mamogram boleh dijalani setahun sekali khususnya buat wanita berusia 40 tahun ke atas.

‘‘Perlu diingat, jika barah dikesan awal bermakna rawatan lebih berkesan dapat dilakukan. Dan, lebih penting pesakit mungkin tidak perlu membuang seluruh payu dara ekoran barah berada di tahap teruk hanya disebabkan ia lewat dikesan,” katanya pada pelancaran kempen kesedaran barah payu dara, Wear It Pink Campaign Trail 2008 di PMC, Bangsar baru-baru ini.

Dr. Devanand berkata, jika wanita kerap melakukan pemeriksaan sendiri, mereka akan sedar andai wujud kelainan pada payu dara, biarpun sedikit.

Beliau yang juga pengerusi kempen tersebut memberitahu, bagi menggalakkan wanita melakukan pemeriksaan payu dara, semua Hospital Pantai akan memberikan potongan harga untuk ujian mamogram sepanjang bulan Oktober dan November.

Apa yang ditekankan Dr. Devanand memang ada kebenarannya. Ketika beliau memperkenalkan beberapa wanita yang didiagnosis mengalami barah payu dara, termasuk mereka yang telah sembuh, jelas rata-ratanya tidak melakukan pemeriksaan payu dara dalam rutin kehidupan mereka apatah lagi PSPD.

Wanita-wanita tersebut adalah ahli kumpulan Kelab Pantai Pink Harmony, isebuah kelab yang ditubuhkan pada Ogos 2008 untuk mereka yang mempunyai barah agar para pesakit dapat bersama-sama meluahkan isi hati dan memberi sokongan antara satu sama lain.

Rosni Osman, 40 - suri rumah

SEBELUM ini dirinya tidak pernah menjalani pemeriksaan atau ujian berkaitan payu dara kerana sangka Rosni, wanita berusia 40 tahun ke atas yang berisiko mendapat penyakit itu. Sedangkan dia ketika itu baru mencecah usia 36 tahun.

Malangnya, barah payu dara kini tidak mengenal usia. Sebaik mengetahui dirinya diserang barah payu dara, Rosni cekalkan hati melalui kehidupan mendatang. Bagaimanapun, kadang- kala kesedihan datang juga menjengah.

‘‘Sehari sebelum pembedahan, saya menangis sepuas-puas hati. Tetapi kemudiannya terfikir, bodohnya aku menangis bukannya hendak berjuang. Jadi, sejak itu saya kuatkan semangat demi anak-anak.

‘‘Saya juga beruntung kerana suami memahami dan memberi sokongan. Dia tidak pernah kisah sama ada fizikal saya cukup atau tidak. Anak-anak turut faham keadaan ibu mereka.

‘‘Sebenarnya, sewaktu mengetahui tentang ‘berita’ ini, suami yang lebih cemas. Namun, saya katakan pada dia, kalau dia berkeadaan begitu, macam mana saya hendak kuatkan diri hadapi semua ini,” kata ibu kepada dua orang anak itu.

Rosni bercerita, dia menyedari ada ketulan di bawah ketiak kirinya ketika sedang menyusukan anak bongsunya yang berusia setahun dua bulan.

Benjolan itu keras dan sebesar telur ayam. Hairannya, dia langsung tidak berasa sakit, tetapi khuatir tentang kesihatan diri dia terus ke klinik pada hari yang sama. Ujian mamogram dilakukan, Rosni positif mempunyai barah payu dara. Untuk lebih tepat, biopsi dilakukan dan jelas barahnya berada di tahap tiga.

Seminggu kemudian, pembedahan dilakukan. Sebelah payu daranya terpaksa dibuang. Kini, Rosni tidak mahu memikirkan perkara-perkara negatif, sebaliknya tabahkan hati dan tetapkan fikiran untuk berfikiran positif.

Amnah Mohammad Salleh, 40

Hatinya berdebar ketika merasai ketulan di bahagian payu dara, masakan tidak, usia Amnah ketika itu baru 20 tahun. Bagaimanapun, dia menarik nafas lega apabila hasil ujian biopsi menunjukkan positif bukan barah.

Hidup diteruskan tanpa terdetik rasa bimbang. Sehinggalah pada akhir tahun 2005, sedang duduk mengadap cermin, Amnah sengaja memegang payu daranya. Terkejut bila dirasa ada ketulan di bawah payu dara kanannya.

‘‘Saya sudah rasa ada sesuatu yang tidak kena. Langsung berjumpa doktor keluarga yang juga mengesahkan ada ketulan dan terus merujuk saya pada pakar. Setelah ujian dilakukan, saya cuma diberitahu, highly suspicious dan jadual pembedahan terus diatur.

‘‘Tetapi, saya tidak puas hati. Ekoran itu, saya dinasihatkan mencari pendapat kedua. Doktor kedua yang ditemui mengesahkan saya positif mempunyai barah payu dara tahap satu,” katanya.

Amnah berkata, tiga hari dia berkurung, tidak bercakap dengan sesiapa. Malah, membalas khidmat pesanan ringkas (SMS) pun dia malas.

Tidurnya juga sering terganggu, asal terjaga pasti menangis. Apa yang difikirkan kala itu semuanya negatif dan timbul juga rasa khuatir, siapalah hendak menjaga tiga anak-anaknya.

‘‘Sampai saya buat rancangan hendak kahwinkan suami dengan pembantu rumah. Masa itu memang tidak pandang jauh. Hanya rasa hendak mati.

‘‘Tetapi, nasib baik saya mendapat sokongan moral daripada Persatuan Kanser Kebangsaan Malaysia (NCSM). Melalui pengalaman mereka yang berjaya melawan penyakit itu, saya bangkit semula,” katanya mengingati kisah lama.

Kini, Amnah sudah bebas daripada penyakit itu dan pengalaman yang dilalui sentiasa dikongsi bersama mereka yang baru didiagnosis barah payu dara dengan menjadi sukarelawan di Persatuan Kebajikan Kanser Payu Dara Wilayah Persekutuan dan Selangor (BCWA).

Sejauh mana makanan mencegah penyakit?

pengambilan tomato dalam diet harian dikatakan baik untuk mengelak barah.

BETULKAH tomato membantu mengelak barah, bawang putih dapat mencegah AIDS atau minum banyak jus buah- buahan menjauhkan diri daripada nyanyuk atau alzheimer?

Meskipun sudah banyak kajian dijalankan, kesan makanan ke atas penyakit-penyakit yang membawa maut masih belum mampu dibuktikan secara total.

Begitupun, ahli sains percaya bahawa, kualiti amalan pemakanan atau diet yang seimbang adalah kunci kepada kesihatan yang baik.

Malah, kerajaan di kebanyakan negara di dunia kerap menggesa rakyatnya untuk mengamalkan corak pemakanan seimbang iaitu - lima bahagian buah-buahan dan sayur-sayuran dan tiga bahagian produk susu dan karbohidrat, manakala lemak, gula dan minuman keras dikurangkan.

Para pakar percaya, apa yang kita makan dapat membantu mengelakkan penyakit seperti diabetes, hypercholesterolaemia (yang membawa kepada penyakit jantung) dan osteoporosis.

Bagaimanapun, para penyelidik masih bercanggah pendapat terhadap hubungan secara langsung antara khasiat makanan dengan penyakit- penyakit seperti barah, AIDS atau penyakit yang berkaitan kemerosotan fungsi saraf (neurodegenerative).

Antara beribu-ribu kajian, satu kajian dilakukan oleh pakar-pakar di Eropah telah menyimpulkan bahawa mengambil serat buah-buahan dan sayur-sayuran mungkin dapat mengurangkan risiko barah usus.

Buah-buahan juga dipercayai dapat melindungi diri daripada jangkitan kanser paru-paru dan prostat. Kajian para pakar Eropah juga menyarankan pengambilan lima cawan teh hijau sehari. Teh hijau dipercayai kaya dengan catechin - bahan polyphenolic anti-oksidan daripada tumbuh-tumbuhan.

Lemak industri atau lemak yang terhasil melalui proses industri, sememangnya diketahui memberi kesan kepada sistem kardiovaskular dan meningkatkan dua kali ganda barah payu dara, sedangkan kacang soya dapat mengurangkan risikonya sebanyak tiga kali ganda.

Bagaimanapun, kacang soya yang kaya dengan anti-oksidan dan membantu sel hidup, boleh meningkatkan risiko ketidaksuburan.

Lycopene, iaitu pigmen merah terang bersifat anti-oksidan yang ada di dalam tomato dan buah-buahan merah lain, juga didapati oleh sebilangan penyelidikan mampu mengurangkan risiko barah, tetapi Pentadbiran Makanan dan Dadah Amerika Syarikat (FDA) menyatakan tidak ada bukti kukuh mengenai dakwaan itu.

Begitupun, alzheimer atau nyanyuk dapat dikurangkan dengan pengambilan pomegranate atau buah delima.

Sememangnya, tidak ada istilah makanan baik atau buruk. Bagaimanapun, mengambil lima bahagian buah-buahan dan sayur-sayuran serta mengurangkan lemak haiwan, merupakan satu tabiat makanan yang baik yang boleh difikirkan oleh sesiapa saja.

Pakar dari Pusat Penyelidikan Makanan dan Kanser Perancis, NACRe, menyebut bahawa diet yang melebihkan pengambilan buah-buahan dan sayur-sayuran dengan tidak terlalu banyak alkohol akan membantu mengelakkan kanser pada mulut, saluran pernafasan, paru-paru, perut, pankreas, usus dan pundi kencing.

Selepas mengumpulkan lebih 7,000 kajian dari seluruh dunia, Dana Penyelidikan Kanser Dunia (WCRF) menyarankan masyarakat mengurangkan pengambilan makanan dan minuman yang tinggi kandungan gula, garam dan lemak, serta mengelakkan makanan yang rendah serat. Sebaliknya, makan buah-buahan, sayur-sayuran, bijirin dan sebagainya..

Corak pemakanan yang baik juga kunci kepada rawatan terhadap pesakit HIV positif memandangkan kekurangan khasiat makanan melemahkan sistem kekebalan tubuh dan mengurangkan ketahanan badan.

Bagaimanapun, makanan yang baik tidak boleh menggantikan anti-retroviral yang perlu diambil oleh pesakit AIDS walaupun terdapat dakwaan oleh Menteri Kesihatan Afrika Selatan, bahawa bawang putih, lemon dan sayur-sayuran dapat memerangi penyakit yang membawa maut itu.

- AFP

Brittle bone disease

Fragile bones can result from a group of genetic disorders that causes imperfect formation of bone.

OUT of 100,000 people worldwide, about six to seven people are affected by osteogenesis imperfecta (also known as brittle bone disease), a group of genetic disorders that mainly affects the bones. Relatively rare, this disorder causes a person to have fragile bones which may fracture easily, often from mild trauma or no apparent cause.

What causes osteogenesis imperfecta (OI) or brittle bone disease?

OI is caused by an abnormality in the genes that code for proteins that are involved in collagen production. As collagen is an important protein in our bones that keeps them strong, people with brittle bone disease have weak bones because they have poor quality collagen in their bones.

There are a few types of OI. The types can be distinguished by their signs and symptoms, although their characteristic features overlap. Increasingly, genetic factors are used to define the different forms of OI.

Who can get OI?

OI can be passed down by either one, or both parents to their child although there are some cases – usually with very bad OI – where OI is caused by a new genetic mutation. OI affects both girls and boys.

What are the signs and symptoms?

The main symptom of OI are broken bones, or fractures. Some babies with severe OI are born with fractures that have taken place in the womb or during delivery. Others have their first fracture soon after they are born.

Usually, young people with OI break bones easily. Just falling over can cause a fracture.

Thankfully, although the bones break very easily, they also mend easily. For reasons unknown, the risk of breaking bones becomes less as a person gets older.

Besides fractures, people with OI can also have:

>Loose joints/ ligaments

>Blue or grey colour of the ‘white’ of the eye - the sclera

>Discoloured or fragile teeth

>Lots of bruises

>Deafness from fractures of bones in the ear

>Hernias

>Excessive sweating

How is OI diagnosed?

The diagnosis is made by doctors from how many broken bones one has had. Other symptoms include blue or grey whites of the eyes. Sometimes someone with OI will have none of these symptoms and diagnosis can be very difficult.

X-rays can sometimes show up old fractures or changes in the bone structure that suggest the condition. But most of the time, x-rays and even bone density scans are surprisingly normal.

Genetic studies on skin samples (biopsies) can sometimes help confirm OI. But a “negative” test does not rule the condition out. It just means you might have an unusual genetic change that has not been found before.

What are the treatments available?

Treatment is mostly good orthopaedic care when people with OI get a fracture. It is important that each fracture heals in a good position, and patients are encouraged to start moving around as soon as possible to keep their muscles and bone as strong as possible for a full recovery.

Bisphosphonates are being increasingly administered to increase bone mass and reduce the incidence of fracture.

For young people who get a lot of fractures, metal rods can be inserted into weak bones to help hold them together and stop them from breaking.

The care of OI patients is a multidisciplinary one. Team members may include an occupational therapist (OT), a physical therapist (PT), nutritionist, an audiologist, an orthopedic surgeon, neurosurgeon, lung specialist, and nephrologist, amongst others.

Compiled from:

1. Osteogenesis imperfecta, U.S. National Library of Medicine, Reviewed November 2007, ghr.nlm.nih.gov/condition=osteogenesisimperfecta

2. Brittle bone disease, Great Ormond Street Hospital, Reviewed September 2007, www.childrenfirst.nhs.uk/teens/health/conditions/b/brittle-bone_disease.html

3. Facts about Osteogenesis Imperfecta, Osteogenesis Imperfecta Foundation, Retrieved October 2008, www.oif.org/site/PageNavigator/AOI_Facts

Sunday October 26, 2008

More than skin deep

By LIM WEY WEN

The signs of psoriasis may only be seen on the surface, but its burden is felt deep down by those who live with it.

OFTEN unexpectedly, psoriasis makes its entrance into people’s lives through various ways. Some experience it first as dandruff with big flakes along with itching and burning on their scalps. Some come face-to-face with red patches covering parts of their body after a bout of intense stress at work, or after an infection.

Dr Allan Yee Kim Chye ... The prevalence of psoriasis is not as high as acne or atopic eczema, but the disease burden is still substantial.

For Mary (not her real name), it began with a seemingly harmless fall. “I was running around my house when I fell and injured myself. A huge part of the skin around my arms was scraped off. Somehow it took a very long time to heal. Plus, the skin around that area began to look scaly and rough. After some time, it began to spread to other areas.

“I went to the doctor and he diagnosed me with psoriasis. My playmates started to ask me ‘what’s that?’ and made fun by calling me all sorts of names. To avoid too many questions I just started to wear long sleeves all the time since then,” she said.

As Mary is the first member in her family to experience such symptoms, her family supported her by going to different places across the globe to find a cure for it.

“I started off with the modern medication of steroids and UV light treatment. It did help to contain it at first, but somehow after some time, they stopped working. Now I’m turning to alternative medicine and strict control of my food consumption,” Mary said.

But perhaps more than her physical condition, one of Mary’s greatest challenges is dealing with the scrutinising eyes of people around her.

I don’t think our society is (that) open yet to judge a person beyond skin deep. I’d rather just be normal than having sympathy or being treated differently, she said.

Indeed, psoriasis is a relatively unknown disease in many parts of the world. “Especially in developing countries, the possibility of getting a correct diagnosis of psoriasis/psoriatic arthritis is extremely limited,” said Lars Ettarp, President of the International Federation of Psoriasis Associations.

“For example, in Tanzania and Kenya, there is only one dermatologist available per one million people. This means a patient has a bigger chance to win the highest score in the national lotto than having a right diagnosis.”

Psoriasis is a chronic skin condition characterised by patches of raised red skin covered by a flaky white build-up. It can cause intense pain and itching, affect daily activities (if it affects hands and legs) and cause severe psychological and emotional pain.

As the visible signs of psoriasis on the skin are often confused with other skin diseases, even amongst general practitioners, problems with stigmatisation arise. As a result, patients face socio-psychological problems in gaining employment, living with their family and functioning within society.

“In a majority of countries in the world, psoriasis is still considered to be just a ‘cosmetic’ disease. And new findings and research results about psoriasis are not spread among the general public, not even among physicians,” said Ettarp, who also has psoriasis.

“Psoriasis is not only a skin disease. It is, in fact, a serious chronic, non-communicable inflammatory disease that affects big parts of the body,” he added.

This year, on World Psoriasis Day (Oct 29), the IFPA aims to create awareness on the burden of disease that greatly impacts the lives of people living with psoriasis (PLWP).

Understanding psoriasis

As global statistics indicate that about two to three people in a hundred could be affected by psoriasis, Mary is not alone.

There are now about 1,500 members registered with the Psoriasis Association of Malaysia (PAM), and most of them have psoriasis, said PAM president Eugene Cross.

Eugene Cross ... My advise to psoriasis patients out there is to join the association so that we can counsel and support them. If they keep it to themselves, it will be an extra burden for them.

A PLWP himself, Cross had spent the past 40 years living with the flares and flakes of psoriasis. From a mild dandruff to being immobilised, he experienced the mildest and worst manifestations of the disease.

“At first it started on my scalp and my doctor thought it was just dandruff.

“But there was a time where I spent eight months completely paralysed as psoriasis lesions covered 80 to 90% of my body. I could not move and had to be carried to the bathroom. I could not flex my arms and legs because my skin could tear just like that.”

While psoriasis symptoms can range from just a mild itch to extreme cases of skin damage like Cross, it is not contagious.

According to consultant dermatologist Dr Allan Yee Kim Chye, the prevalence of psoriasis is not as high as acne or atopic eczema, but the disease burden is still substantial. Although psoriasis is often hereditary, it can arise in persons with no family history.

Some of the telltale signs of psoriasis include pink, scaly patches on the outsides of their knees and elbows on patient’s scalps. “What distinguishes scalp psoriasis from dandruff is that the lesions in psoriasis are discrete patches and have thicker scales, whereas dandruff €“ even the severe ones €“ is usually spread over the scalp and the scales are finer,” said Dr Yee, who is also the medical advisor to PAM.

Some PLWP may also find their nails discoloured or separated from their nail beds. In 10-20% of cases, there may be disruption of the joints, Dr Yee said.

Apart from the physical pain from the itching, burning, flaking and scaling from patient’s skin, the social and psychological impact are equally painful.

“Skin disease, whether it is psoriasis or acne or scars, often come with disproportionate social penalties,” Dr Yee said.

“Studies have shown that acne sufferers have lower job prospects than unblemished persons. Psoriasis sufferers with visible disease on the face or other cosmetic areas and also the hands may suffer some degree of stigmatisation from the lay public who do not understand that the condition is not contagious.”

Among the five types of psoriasis €“ plaque psoriasis, guttate psoriasis, erythrodermic psoriasis, inverse psoriasis and pustular psoriasis €“ plaque psoriasis is the most common.

An alteration in the immune system speeds up the growth cycle of skin cells, causing the cells to pile up and form thickened scales on the skin surface rather than shedding it slowly.

The exact cause of psoriasis is not yet known, but a preliminary report of a pilot study of the Malaysian Psoriasis Registry in 2005 found 57% of patients who reported one or multiple factors which aggravated their psoriasis.

The most common factor was stress, followed by sunlight, infection, trauma and other factors such as drugs, alcohol, some topical medication and pregnancy.

“Different people have different triggers. So, we tell our members that when you have a flare-up of psoriasis, if you have no stress, look at your food. If you find a certain food that irritates you, stop taking it,” Cross said.

By identifying the triggers, people with psoriasis could tailor their lifestyles and habits to prevent flare-ups. As there is currently no cure for psoriasis, avoiding factors that triggers its symptoms is of utmost importance.

The skin and beyond

Today, we know that psoriasis (including psoriatic arthritis) is a systemic disease involving the immune system, Ettarp said.

An alteration in the immune system speeds up the growth cycle of skin cells, causing the cells to pile up and form thickened scales on the skin surface rather than shedding it slowly. In other words, the amount of skin shed in a psoriasis patient in three days can be almost similar to the amount a person without psoriasis would shed in 28 days, Cross explained.

However, recent studies have compelled doctors to look beyond the skin into other complications associated with psoriasis.

“In adults, severe psoriasis is associated with the metabolic syndrome, entailing a risk for type 2 diabetes, obesity and cardiovascular disease. The first study which showed increased risk of cardiovascular diseases and mortality was published in Sweden in year 2005, and has been followed by a number of other studies,” Ettarp said.

With more data, various health recommendations for people with psoriasis were issued by health organisations.

The American Heart Association recommends psoriasis patients above 40 years old to screen for blood pressure, body mass index, waist circumference, fasting lipids, and fasting sugar every two years. Patients are also advised to stop smoking, take alcohol moderately, and exercise.

As psoriasis is not a fatal disease, its progress in research is often hampered by inadequate funding as priorities are given to diseases like cancer, Cross said. Fortunately, with increased advocacy and awareness, more research has been done, and patients could have more treatment options now and in the future, he added.

To keep its members updated, PAM sends out bulletins to all their members at least two or three times a year. Relevant information €“ from new treatment options to how to date €“ are included to make the bulletin an informative and interesting read.

“My advise to psoriasis patients out there is to join the association so that we can counsel and support them. If they keep it to themselves, it will be an extra burden for them,” Cross said.

“When you share your experiences, you will find your burden lighter and easier to live with. You can also come to learn more about psoriasis and how to deal with it.”

For more information about psoriasis, visit:

1. Dermatological Society of Malaysia - www.dermatology.org.my

2. Psoriasis Association of Malaysia - www.psoriasismalaysia.org or tel: 03-89484335, fax: 03-89481537

3. International Federation of Psoriasis Associations (IFPA) - www.ifpa-pso.org