World Psoriasis Day was marked on October 29 and people with the disease are now increasingly coming forward to speak not only about its debilitating physical effects but the intense emotional burden the disease brings with it. A skin condition, psoriasis is associated with thickened, reddened skin which causes irritation, but even more noticeable are the flaky, silver-white ‘scales’ that sufferers shed. Patients with the disease may struggle with chronic itching and pain from the cracking and bleeding of their skin, explains Dr. K. Satgurunathan, Consultant Dermatologist, explaining that some develop the associated disorder of psoriatic arthritis.
Psoriasis is a particularly isolating condition because it is so misunderstood, explains Dr. Satgurunathan, adding that he believes Psoriasis Day should be used to push for improved access to treatment for patients and to combat the many myths that abound about the disease. One of the most common is that the disease is contagious, which it is not. “You cannot catch it from another person,” Dr. Satgurunathan assures. Other myths include the belief that psoriasis is caused by poor personal hygiene, when in fact it is an auto-immune disease with its roots in a genetic predisposition.
It must be noted, however, that psoriasis flare up can be triggered by external stimuli such as extreme stress, infections, trauma, hormonal changes and even certain medications. As always, there is nothing that excessive alcohol consumption and smoking can’t make worse, and psoriasis is no exception. Another misconception is often that psoriasis is mainly a cosmetic problem. “Some people believed that it affects just the skin and the joints, but it is now known that psoriasis affects other systems as well. For a lot of people, psoriasis is associated with obesity, heart disease, diabetes and hypertension,” explains Dr. Satgurunathan
That having been said, the cosmetic aspect of the disease has a profound and disheartening effect on the lives of those diagnosed with it. For many, the humiliation of shedding their scales over clothes and nearby furniture makes it difficult to go out. Even in milder cases, flaking on the scalp is often mistaken for dandruff, embarrassing the patient. Forming relationships and holding down jobs can prove challenging for many of them, and the disease has a very negative impact on self esteem. Psoriatic arthritis brings with it its own problems – limiting mobility and creating disfigurement, particularly in the small joints of the hand. The arthritis develops in an estimated 10% of the psoriasis cases and can be made dramatically worse by mental stress of any kind.
There are many different kinds of psoriasis. Plaque psoriasis is the most prevalent form, accounting for 80% of cases worldwide. In this type, the raised, inflamed, red lesions typically appear on the elbows, knees, scalp and lower back and are covered in silvery white scales. Another form of psoriasis is known as Guttate and this type often first appears in children and young adults. Here red spots appear on the skin, but are not usually as thick as the plaque lesions. Other types of psoriasis include Inverse psoriasis (which is found in places like the armpits, groin and under the breasts, places which are particularly uncomfortable for overweight people and others with deep skin folds) and Pustular psoriasis in which blisters filled with white pus are surrounded by reddened skin.
Yet another form of psoriasis presents perhaps the most serious consequences. In Erythrodermic psoriasis, the whole body may be covered in inflamed skin which is then shed. As a result, patients may experience severe protein and fluid loss. The condition has also been associated with infections, pneumonia and congestive heart failure and can require hospitalization.
An estimated 1% of Sri Lankans have psoriasis, says Dr. Satgurunathan, explaining that this figure is drawn from fairly old studies. Globally, the disease is believed to affect 1-3% of the population. The population most at risk appears to be adults, but there have been children with cases of psoriasis as well. Among these, many patients are unaware that they have psoriasis, as it is sometimes confused with other skin conditions such as dermatitis, eczema, or allergic rash. In such cases a correct diagnosis is an essential first step.
For those who do receive this, the lack of a cure can be very disheartening. However, “while psoriasis is not curable, it can be very effectively controlled with medication,” emphasises Dr. Satgurunathan, adding that especially when the precipitating factors can be managed effectively, a patient might be able to go for years without a serious flare up. There is no one standard treatment, however, and patients may have to find what works for them.
Treatment options rely on a combination of drugs that can be taken orally as well as topical applications. Unfortunately many cutting edge drug therapies remain too expensive and difficult to access in Sri Lanka. Raising awareness on Psoriasis Day might be one way in which to encourage authorities to rectify the situation.