Psoriasis: symptoms, scalp psoriasis, triggers and treatment in Malaysia
Psoriasis is a long-term immune condition that causes thick, scaly patches of skin, most often on the scalp, elbows, knees and lower back. It isn’t contagious, and while there is no cure, today’s treatments can clear the skin for most people. Here is how to recognise it and how it is treated in Malaysia.
Key points
- Psoriasis is an immune-mediated skin disease, not an infection. You can’t catch it or pass it on by touch.
- Plaque psoriasis, with thick, well-defined, scaly patches, accounts for 80–90% of cases. On brown skin, plaques often look dark brown, purple or grey rather than red.
- Stress, infections such as strep throat, smoking, alcohol, weight gain, skin injury and some medicines can trigger flares.
- About 1 in 5 people with psoriasis develop psoriatic arthritis. See a doctor about swollen joints, a “sausage” finger or toe, or morning stiffness.
- Treatment goes step by step: moisturisers and creams, then light therapy, then tablets or injections. Biologic injections are given in government dermatology clinics.
What is psoriasis?
Psoriasis is a chronic, immune-mediated inflammatory disease that mainly affects the skin and joints. An overactive immune system speeds up the growth of skin cells, which build up into thick, scaly patches called plaques. It runs in families, and usually comes and goes in flares throughout life.
It is not contagious. You can’t catch psoriasis from touching someone, sharing a towel or swimming in the same pool.
In Malaysia, a study of primary care records in Johor Bahru, quoted in the Ministry of Health’s 2024 psoriasis guideline, found that about 3 in every 1,000 people (0.34%) have psoriasis, with higher rates among Indians (0.54%) than Malays (0.38%) and Chinese (0.29%). The Malaysian Psoriasis Registry, which follows more than 8,800 patients, shows symptoms typically start in the 30s, with a second peak in the 60s. Children can get it too. About 1 in 4 patients has a family member with psoriasis.
Symptoms: what psoriasis looks like
- Thick, raised, scaly plaques with sharp edges, often on both sides of the body, on the scalp, elbows, knees, lower back and buttock crease.
- Colour depends on skin tone. On lighter skin, plaques look pink or red with silvery-white scale. On brown skin, they often look dark brown, purple or greyish, and can leave dark or light marks for 3 to 12 months after they clear.
- Itch: more than 3 in 4 Malaysian patients in the registry report itching.
- Nail changes: small pits on the nails, or nails lifting away from the nail bed. More than half of Malaysian adults with psoriasis have nail involvement.
Types of psoriasis:
| Type | What it looks like |
|---|---|
| Plaque (the most common, 80–90%) | Thick, scaly, well-defined patches on the scalp, elbows, knees and back |
| Guttate | Many small, drop-shaped spots, often appearing suddenly in children and young adults after a strep throat infection |
| Inverse (flexural) | Smooth, shiny patches without much scale in skin folds: armpits, groin, under the breasts |
| Pustular | Pus-filled spots that aren’t infected, on the palms and soles or, rarely, all over the body |
| Erythrodermic | Rare: red, inflamed skin over most of the body. This is an emergency |
Scalp psoriasis or dandruff?
About 1 in 3 Malaysian adults with psoriasis have it on the scalp, face or genitals. Scalp psoriasis is often mistaken for dandruff (seborrhoeic dermatitis), and the two can occur together.
| Scalp psoriasis | Dandruff / seborrhoeic dermatitis | |
|---|---|---|
| Scale | Thick, dry, silvery, stuck on | Greasy, yellowish, flakes off easily |
| Edges | Sharp, raised plaques | Less defined |
| Spread | Often goes past the hairline onto the forehead, neck or behind the ears | Usually stays within the scalp, eyebrows and sides of the nose |
| Elsewhere | Often plaques on elbows, knees or nails too | Usually no plaques elsewhere |
Medicated scalp gels, coal tar shampoos and combination steroid and vitamin D gels prescribed by a doctor work better than ordinary anti-dandruff shampoo for scalp psoriasis. Don’t pick or scratch off the scale, as injuring the skin can make psoriasis worse.
Psoriasis, kurap (ringworm) or eczema?
- Kurap (ringworm, tinea) is a fungal infection. It usually forms an itchy ring with a clearer centre and a scaly, spreading edge, and is often on one side of the body. A doctor can confirm it by looking at a skin scraping under a microscope.
- Eczema tends to have less sharply defined edges, often appears in the inner elbows and behind the knees, and is usually itchier. Psoriasis plaques are thicker and more often on the outer elbows and knees. See our guide to itchy skin, eczema and hives.
Be careful with steroid creams and “miracle” creams
Steroid creams used on a fungal infection can hide it and help it spread, so get a diagnosis before treating a rash for weeks. Avoid unregistered creams sold online or at markets: the Ministry of Health has found steroids such as betamethasone hidden in some cosmetics, which can thin and damage the skin. Check that a product is registered on the NPRA website or the NPRA Product Status app.
What triggers psoriasis flares?
- Stress: the most common trigger reported by Malaysian patients (about 2 in 3).
- Infections: especially strep throat, which can set off guttate psoriasis. See our guide to coughs and chest infections.
- Skin injury: cuts, scratches, insect bites or sunburn can cause new plaques at the injured spot (the Koebner phenomenon).
- Smoking, alcohol and weight gain.
- Some medicines: including certain blood pressure tablets (beta-blockers and ACE inhibitors), lithium, antimalarials, some anti-inflammatory painkillers (NSAIDs), and stopping oral steroids suddenly. Never stop a prescribed medicine on your own; ask your doctor whether it could be a trigger.
Some sunlight often helps psoriasis, but about 3 in 10 Malaysian patients say too much sun makes it worse. Avoid sunburn.
Psoriatic arthritis: check your joints
About 1 in 5 people with psoriasis develop psoriatic arthritis (19% in the Malaysian registry), and many cases go undiagnosed. In most Malaysian patients, the skin problem comes first and the joints later. Untreated, it can permanently damage joints, so the Ministry of Health guideline recommends checking for it at least once a year.
See a doctor if you have:
- painful, swollen joints, especially in the fingers and toes
- a whole finger or toe swollen like a sausage (dactylitis)
- pain where tendons attach to bone, such as the back of the heel
- back pain and stiffness that is worse in the morning and better with movement, or morning stiffness lasting more than 30 minutes
Psoriasis, your heart, weight and mood
Psoriasis isn’t only skin deep. The inflammation affects the whole body, and people with psoriasis, especially moderate to severe psoriasis, have a higher risk of heart attack and stroke. Among Malaysian adults in the psoriasis registry:
- 63% were overweight or obese
- 29% had high blood pressure
- 23% had high cholesterol
- 19% had diabetes
It is worth having your blood pressure, cholesterol and blood sugar checked regularly. See our guides to blood pressure and cholesterol and normal blood sugar levels. Psoriasis is also linked to depression and anxiety, and more than 1 in 3 Malaysian patients say it has a very large effect on their quality of life. If it is getting you down, tell your doctor. See our guide to anxiety.
Psoriasis treatment in Malaysia
The Ministry of Health’s guideline, Management of Psoriasis (2nd edition, 2024), sets out treatment step by step. The aim is clear or almost clear skin (less than 3% of the body affected) and little effect on daily life within 12 to 16 weeks.
- Moisturisers every day, to soften scale and reduce itch.
- Creams and ointments for mild psoriasis: steroid creams are first-line. Doctors may add a vitamin D cream (calcipotriol, alone or combined with a steroid), coal tar, salicylic acid to lift scale, or dithranol for stubborn plaques. Gentler non-steroid creams are used on the face and skin folds.
- Light therapy (narrowband UVB phototherapy) for more widespread psoriasis, given 2 to 3 times a week at hospital dermatology units. It is not available at every centre.
- Tablets such as methotrexate (the most commonly used), acitretin or ciclosporin, for moderate to severe psoriasis. They need regular blood tests. Acitretin must not be taken by women who may become pregnant without reliable contraception.
- Biologic injections and newer oral treatments, which target specific parts of the immune system, for severe psoriasis or when other treatments haven’t worked. Biologics are given in government dermatology clinics. Cost is a barrier, and funding can come from sources such as the civil service scheme for government staff, hospital funds or medical aid funds.
Psoriasis is considered moderate to severe if it covers more than 10% of your body (your palm and fingers are about 1%), affects the face, scalp, palms, soles or genitals, or seriously affects your daily life. In those cases, you may need light therapy, tablets or injections rather than creams alone.
When to see a doctor
- You have a scaly rash that hasn’t gone away, and you aren’t sure what it is.
- Your psoriasis isn’t improving after 12 weeks of creams, or covers a large area.
- It affects your face, scalp, hands, feet or genitals, or is affecting your sleep, work or mood.
- You have joint pain, swelling or morning stiffness.
A GP or Klinik Kesihatan can diagnose and treat most mild psoriasis, check for related conditions, and refer you to a government hospital dermatology clinic if you need specialist care.
Get urgent medical help
Go to a hospital emergency department if your skin suddenly becomes red and inflamed over most of your body, or you develop widespread pus-filled spots with fever, chills or feeling very unwell. These rare forms of psoriasis can be dangerous.
Where to see a doctor about psoriasis
A GP is a good first step for a rash that keeps coming back. They can confirm whether it is psoriasis, start treatment, check your blood pressure, sugar and cholesterol, and refer you to a dermatologist if needed. Our directory lists GP clinics across Kuala Lumpur, Selangor and other states, including clinics open in the evening and at weekends.
Browse the clinic directoryFrequently asked questions
Is psoriasis contagious?
No. Psoriasis is caused by the immune system, not an infection. You can’t catch it or pass it to others by touch, sharing towels or swimming.
Can psoriasis be cured?
There is no cure yet, but treatment can clear or nearly clear the skin for most people. Psoriasis tends to come and go, so many people need ongoing or repeated treatment.
How do I know if it is scalp psoriasis or dandruff?
Scalp psoriasis has thick, dry, silvery scale with sharp edges that often spreads past the hairline, and there are often plaques elsewhere on the body. Dandruff has greasy, yellowish flakes that come off easily.
Is it psoriasis or kurap (ringworm)?
Kurap is a fungal infection that usually forms an itchy ring with a clearer centre and a spreading edge. Psoriasis plaques are thick and scaly throughout, often on both elbows or knees. A doctor can check a skin scraping to be sure.
What triggers psoriasis?
Common triggers include stress, infections such as strep throat, skin injury, smoking, alcohol, weight gain and some medicines, including certain blood pressure tablets and lithium.
What is psoriatic arthritis?
It is joint inflammation linked to psoriasis, affecting about 1 in 5 people with psoriasis. Signs include swollen, painful joints, a swollen “sausage” finger or toe, heel pain and morning stiffness. See a doctor early to prevent joint damage.
Are biologic injections available in Malaysia?
Yes. Several biologics and newer oral treatments are used in Malaysia, including in government dermatology clinics, for severe psoriasis or when other treatments haven’t worked.
Sources
- Ministry of Health Malaysia (MaHTAS) — Clinical Practice Guidelines: Management of Psoriasis, 2nd edition (2024)
- Dermatological Society of Malaysia — Twelfth Report of the Malaysian Psoriasis Registry 2020–2022 (2024)
- American Academy of Dermatology — Psoriasis: causes
- American Academy of Dermatology — Psoriasis in skin of colour
- Mayo Clinic — Scalp psoriasis vs seborrhoeic dermatitis
- DermNet — Tinea corporis
- NPRA — Press release on a cosmetic product containing betamethasone (June 2023)
