Psoriasis leaves a mark on you - both literally and figuratively.
This chronic autoimmune disease can affect any part of the body, causing raised red patches of skin covered with a flaky, white layer of dead skin cells. These lesions are usually itchy, and can also be painful.
Although it is not contagious, psoriasis patients frequently feel uncomfortable going out in public when they have a flare-up. This is due to self-consciousness, low self-esteem, and embarrassment, as well as the stares and prejudice they sometimes encounter from society.
Social isolation and depression are also commonly associated with this disease.
As one of the most common human skin diseases, psoriasis affects around two to three per cent of the global population. Famous (and infamous) people who have had psoriasis include country singer LeAnn Rimes, America's Next Top Model 2006 winner CariDee English, comedian and actor Jon Lovitz, novelist John Updike, Colombian drug lord Pablo Escobar, communist leader Joseph Stalin and American statesman Benjamin Franklin.
In fact, both Rimes and English are spokespersons for the National Psoriasis Foundation in the United States.
And if you are a fan of the reality show Keeping Up With The Kardashians, you will know that celebrity Kim Kardashian was also diagnosed with psoriasis on an episode of the show just last month.
Kardashian, aged 30, falls right into the age range of 15 to 35, when most psoriasis patients have their first flare-up.
The first time
The first time
Similarly, both Atma Singh Lahre and Dominic Wong had their first encounter with psoriasis in their mid-to-late 20s.
Lahre, 75, remembers having very bad "dandruff" and scaly lesions on his scalp in his mid-20s.
"This was before I got married in 1964," says the retired civil servant. "I never knew at that time that it was psoriasis as we didn't have many dermatologists around then."
However, a bad flare-up of the condition caused him to go see a doctor, who accurately identified it as psoriasis.
"He said there was no cure for it.
"I said, that's impossible, how can there be no cure for something on the scalp? So I tried all sorts of things, like washing my head with lime, using anti-dandruff shampoo, applying curd onto my scalp, and so on," says Lahre.
Sometimes, the treatments would work, but his scalp psoriasis always came back again.
Then, in 1974, during his posting to Kota Baru, the avid fisherman had an encounter with jellyfish while fishing in the sea.
"The next day, my whole body became very hot and itchy and red," he says. When the cream the doctor gave him didn't work, the doctor performed a skin biopsy and confirmed that his psoriasis had spread to the rest of his body.
Further treatment did not work either, so the doctor decided to refer him to the Kuala Lumpur General Hospital (HKL), which had more facilities available. "They treated me in HKL, and I got better, but every year (after that), there is a relapse, and I had to be admitted to the hospital for one to two weeks."
However, for the last 10 years, Lahre has not experienced any flare-ups, and says he is now "95% free of psoriasis".
For Wong, 36, it started with a streptococcal throat infection, following a bad bout of the flu. "One day (after that) while I was working, I noticed a red spot on my body. When I went home, I checked and saw a few more.
"Over the next few days, they spread to the rest of my body," shares the marketing manager.
The reality and impact of the disease struck him in three stages. "The first blow is, why is it spreading? The second blow is, when the doctor said it was incurable. And the third blow is, (when you ask) why me?" he says.
Dealing with the stigma of psoriasis is hard enough for adults, so imagine what it is like for the 10-15% of patients who get it in their childhood, and grow up with it.
Rimes and English know what it is like to grow up with psoriasis, as their first experience of it was at the ages of two and five respectively.
Their psoriasis was also quite extensive, with Rimes having around 80% of her body covered with it at the age of six, while English had a flare-up just last year, affecting 70% of her body.
In a 2008 interview with EverydayHealth.Com, Rimes says: "I was a kid with it, so I understand what kids go through, not wanting to be around people, not wanting to do normal activities.
"I was always afraid to be in a bathing suit in the summer. Every time I got a scratch playing a game, the psoriasis would come up, so I had to be incredibly careful.
"As a little girl, it was like, 'I'm not pretty, I'm not normal'.
"But you learn very quickly where beauty comes from, which is a major life lesson for a child to have to learn; beauty's not just my skin, it's not just on the outside.
"And the more you talk about it, I think the more it helps."
As a teen star, Rimes says that the psoriasis did not stop her from doing what she wanted. However, the pressures of performing made her sometimes take stronger doses of the medications than was recommended for children, so that the lesions would clear up faster.
But this resulted in her relapsing faster, and feeling fatigued most of the time.
English admits in a 2009 press conference in conjunction with World Psoriasis Day that she "prayed every day not to have this disease".
In a 2010 interview with AOL's Stylelist.com, English shares that her mother, who also has the condition, tried to empathise with her as a teenager. "She has a much lighter case, I'm more severe.
"When I was a teenager, she would try to relate to me, but I'd say, 'You just have it on your knees and elbows, I have it all over! There's no way you know what I feel like!'
"But she got me in to see a doctor right away, because she knew it was a disease and had to be treated."
Getting a good doctor
Getting a good doctor
In fact, one of the most important things a psoriasis patient can do is to find a suitable dermatologist.
Says Wong: "It is very important that you find a good dermatologist. Find one that you can talk to, and who is up-to-date with the latest treatments."
For him, it was important that his dermatologist was virtually connected, practical and pragmatic, as Wong works a lot on the Internet and values those characteristics.
"My dermatologist is well connected to the Net, so I feel comfortable shooting off an email to him, and he will reply quite promptly," he says,
However, he also emphasises the importance of patients being proactive and reading up about the disease themselves.
"People need to know what are their options: how to control it, what triggers their flare-ups, how to get help, and what are the co-morbidities," he says.
Stress, food and infections appear to be among the most common trigger factors for psoriatic flare-ups,
For Wong, shellfish and fried foods tend to set off his psoriasis. As such, he describes himself as a "very boring" lunch partner. "The best place for me to have lunch is at the chap fan (mixed rice) place, so that I can at least choose non-fried food," he says.
Meanwhile, Lahre shares that he has always been allergic to seafood and peanuts, but says that it can be difficult to control the diet when eating out, as you would not know all the ingredients in the food other people cook.
He thinks that his own annual flare-ups may be associated with the weather as he usually has to be admitted to the hospital for treatment when it starts getting warmer in June.
As not everyone will have the same trigger factors, it is important for patients to take note of what activates their psoriasis, so that they can avoid it.
Treating it right
Treating it right
The same goes for treatment.
Medical treatment is, of course, important. However, in both Lahre and Wong's experience, the efficacy of the same external treatments tend to decrease after a while.
Says Lahre: "Psoriasis is such that when you apply something new, it will disappear. But then it will come back and the medicine doesn't work any more."
Wong agrees, and says that he overcomes this problem by rotating his creams and ointments, and experimenting with using medications meant for one part of the body, on another.
There are also many alternative and home therapies for psoriasis out there; many of which have no scientific evidence to back them up.
Says Lahre: "You need to be careful (with these therapies). Just apply a small amount on your skin, and quickly wash it off if there is a problem."
And both he and Wong say that any such treatments should always be checked by the dermatologist before being taken or applied.
Wong adds that he would also never take any alternative treatment that needed to be ingested.
Studies have also shown that psoriasis is associated with other chronic conditions like diabetes, cardiovascular disease and hypertension.
"Especially now with the co-morbidities, it's really important to get healthy," says Wong.
Eating right, exercising and having relaxing routines to decrease stress are all important elements in a healthy lifestyle, and are particularly relevant to psoriasis patients to help control their condition.
Says Wong: "Don't lose hope, do your best, and one day the cure will come."