The persistent nature of psoriasis makes it challenging to manage. Here’s how to cope.
Last year while promoting the film Suicide Squad, English model-turnedactor Cara Delevingne was seen with painful-looking sores on her back and arms. Delevingne has frequently spoken about suffering from psoriasis, and this was a flare-up. According to a new survey conducted by global research firm GFK (Gesellschaft für Konsumforschung) across UP, Maharashtra, Bihar, West Bengal, Tamil Nadu, Karnataka, Punjab and Delhi, 66 per cent of sufferers have experienced discrimination or humiliation because of the condition that typically manifests as a rash, but is not a skin disease. Here’s what causes the condition and how to manage it.
What is psoriasis?
Clinical dermatologist Dr Sushil Tahiliani, who is also a member of the special investigation group on psoriasis formed by the Indian Association of Dermatologists, says, “Psoriasis is an immunologically mediated condition largely seen in genetically pre-disposed individuals. It’s not an autoimmune disease where the immune system targets the entire body. Here, the immune system is responsible for attacking some parts of the skin because in those areas, the skin gives out wrong signals. It’s important to understand that this is not a skin disease. It is perceived to be so as its manifestations are mainly on the skin. It also has manifestations on the tendons and joints.”
According to him, approximately 2 per cent of the world’s population has psoriasis. “In certain communities like Eskimos, it’s very rare as they don’t cross breed and their community doesn’t have genes that causes psoriasis. But 4-9 per cent of the population in Scandinavian countries suffers from this condition. In India, it affects approximately 2-3 per cent of the population.”
Skin specialist Soma Sarkar says, “In psoriasis, pathogenic T cells are activated, thereby releasing chemicals that causes the inflammation and leads to an abnormal growth of skin and the swelling of the blood vessels underneath. When these T cells are activated, they behave like they are fighting a wound and in turn release a lot of chemical signals which causes the skin to have abnormal growth. So, the skin builds up more than it can shed, thus causing a plaque of psoriasis.”
It can occur at any age but is more prevalent in people with metabolic disorders like diabetes and those who suffer from increased triglycerides and cardiovascular diseases. Dermatologist Dr Apratim Goel says, “Factors like stress, high blood pressure; extreme cold temperature and trauma (Koebner phenomenon attributed to German dermatologist Heinrich Köbner, which refers to skin lesions caused due to trauma) also trigger this condition. People suffering from metabolic syndrome (obesity; hypertension; dyslipidemia; insulin resistance) are at a higher risk of this disease because of the presence of similar pro-inflammatory mediators.”
Types of psoriasis
‘Plaque psoriasis,’ the most common form of this condition, manifests as red patches covered with a silvery-white build-up of dead skin cells or scales. This is typically seen on the scalp, knees, elbows and lower back. Itchy and painful, these scales may even crack and bleed. Dr Sarkar explains: “‘Guttate psoriasis’, which manifests as as small, red lesions on the skin, is mostly seen in children and it is caused due to a respiratory or throat infection. It can appear all over the body. ‘Pustula psoriasis’, comprising white pustules surrounded by red skin, is mostly seen on the palms and soles.
‘Inverse psoriasis’, manifests as red lesions mainly in skin folds (like the groin and in armpits) where there is a lot of friction. In ‘nail psoriasis’, the hard surface on top of the nails starts losing keratin cells. As a result, pits form over the nails. In some cases, it can also destroy the nail bed.”
According to Dr Tahiliani, up to 20 per cent of people who have psoriasis develop psoriatic arthritis. “It can either affect the fingers and toes or it can appear on the heels. It can also affect one or two major joints like the shoulder, knees or the spine. Depending on the joints which are affected, the patient might first experience morning stiffness which can last up to half an hour. If the joints become swollen, red and tender and are not treated adequately, it can lead to permanent immobility.”
It takes a toll psychologically
Psoriasis is a long-standing condition and can affect the patient psychologically. As it affects a person’s physical appearance, in some cases it may affect the sufferer’s sense of self-esteem severely. Dr Goel says, “As the lesions heal, the skin starts to darken. Moreover, the disease can spread to joints which can affect the body’s movement because of the swelling and pain over the lesions. If scaling is in excess, it can lead to protein loss and also temperature dysregulation (where a patient may feel hot or cold despite no change in the actual temperature of the environment).
Psoriatic arthritis is a painful condition. Even simple things like sleeping, standing or walking become difficult for patients, making them dependent on others. This too takes a toll on one’s self-confidence.”
Dr Tahiliani adds, “People with untreated psoriasis become reclusive. It is not contagious but a lack of knowledge can make others wary. It’s not uncommon for sufferers to stop attending social events and lose self confidence. This can cause social isolation.”
Treatment
Treatment is available in various forms — oral therapy, steroids, topical applications, emollients and injectables (these act on the chemicals released by the T cells), are all available depending upon the severity of the disease. Dr Goel says, “For mild cases, topical steroids complemented with moisturisers and antihistamines are effective. For moderate cases, topical steroids, moisturisers, phototherapy with UVB radiation or UVA radiation are recommended. In severe cases, topical treatment with phototherapy and oral medications are recommended. In case of psoriatic arthritis, non-steroidal anti-inflammatory drugs and physiotherapy are advised.”
Counselling also forms an integral part of treatments. Dr Tahiliani says, “The patient has to understand the disease and learn to be patient. He or she must also be regular about follow-ups.”
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