Living with psoriasis

Among all health problems, skin disorders are the most feared. This is probably because while other illnesses remain hidden, diseases of the skin are visible to others. Besides, the unhealthy appearance of the body makes it a constant source of disgust and worry.

Psoriasis is one such condition, which distorts the appearance of the normal skin. The patches of psoriasis appear bright, salmon pink and the surface shows layers of mica-like silvery scales. Fortunately, there is no associated itching or oozing from the patch. The most commonly affected areas include the scalp; the skin overlying joints such as knees, elbows, ankles and knuckles; palms and soles. In severe cases, the patches appear on any part of the body.

Psoriasis can develop at any age but is often seen in young adults. In women, there is a spurt in its frequency during puberty and menopause. Although psoriasis is rarely seen from birth, some infants may develop it in the areas associated with diapers.

Mysterious cause of psoriasis

Despite decades of scientific research, the exact cause of psoriasis has not been identified. It is thought to be genetically inherited although dermatologists come across many individuals without such family history. Researchers suggest that it could be due to an immune system malfunction.

What worsens psoriasis?

Psoriasis occurs more often during winter when the skin becomes dry; it also flares up during episodes of intense mental stress. Another peculiar behaviour of this disease is that new areas of psoriasis can occur anywhere if the skin gets scraped or scratched. Friction-prone areas like hands and feet frequently keep developing psoriasis despite proper treatment.

Complicated types of psoriasis

If left untreated, psoriasis may progress to one of the three complicated forms.

• Exfoliative dermatitis: The entire skin of the person is shed off in flakes and the body appears flushed. The person appears weak due to loss of protein from the skin.
• Pustular psoriasis: The chest, abdomen or the limbs show large ‘lakes’ of pus-filled areas. The underlying skin is bright red and the patient appears to be in a state of exhaustion.
• Arthropathic psoriasis: This type of psoriasis is accompanied or preceded by swelling and pain in major joints of the body, for instance, knees, ankles, lower back, fingers and toes. The patient becomes virtually immobile and may require to be hospitalised. Over a period of time, the joints may get deformed and mobility is compromised.

Special types of psoriasis

• Flexural psoriasis: This type affects the groins, underarms, area below the breasts and other body folds. The skin appears red and raised with minimal scaling.
• Palmo-plantar psoriasis: It appears as thick, dry, scaly patches. In some cases, the scales lose their silvery character.
• Sebopsoriasis: The co-existence of seborrheic dermatitis [dandruff] in psoriasis is termed as sebopsoriasis. In this type, the scalp, eyebrows and areas behind the ears are affected.
• Nail psoriasis: Nail damage may precede skin lesions. The nails have pits, linear ridges, and discolouration.
• Oral psoriasis: Psoriasis rarely affects the mouth. It is a feature of pustular psoriasis and exfoliative dermatitis. Grey, yellow or whitish plaques or ring-like lesions are found in the mouth, palate and tongue. The lips may have silvery scales.

Uncomplicated psoriasis is never fatal. Even with complications, the currently available treatment methods ensure that the patient improves and resumes normal life.

How is psoriasis treated?

The unfortunate part of psoriasis is that the perfect treatment is yet elusive. Treatment of psoriasis yields good results but the response may not be long-standing. The disease has many cycles of remissions and relapses—the disease disappears and reappears periodically. Due to its embarrassing appearance, it affects people in their day-to-day lives.

Creams and ointments containing corticosteroids, tar, calcipotriol, calcipotriene, tazarotene, tacrolimus and moisturisers are prescribed in sequence till the lesions disappear. Tablets containing vitamins, fish oils, steroids, psoralens, acitretin, methotrexate and cyclosporine are given orally depending on the severity of the condition. Most patients respond to these drugs and remain free of symptoms for months together.

Combining oral tablets with exposure to specific rays of ultraviolet light [PUVA therapy] helps patients who do not respond to the above treatment.

One of the recent developments is the availability of special compounds known as ‘biologicals’, which are injected weekly for several months for clearing complicated forms of psoriasis. Etanercept is one such drug now available in our country, but its prohibitive cost prevents it from being prescribed to most patients who do not have health insurance.

There are also some reports of a specialised type of laser—Excimer laser—being useful in treating psoriasis although more studies are required before it can be recommended as an effective therapy.

Exfoliative, pustular and arthropathic psoriasis need to be treated by skin specialists [dermatologists] as the patient may require hospitalisation and high intensity medications.

Don’t self-medicate, please! It must be clearly understood that certain medicines are prescribed only by specialists for short periods of time, after confirming that the patient is not planning a family in the near future.

There is a high likelihood of abnormal pregnancy, if women of child-bearing age consume this drug.

Drugs like methotrexate and cyclosporine too are prescribed by dermatologists cautiously as self-medication could lead to major complications.

How to prevent relapse of psoriasis

People suffering from psoriasis can prevent repeated attacks by observing some precautions. Most doctors who treat psoriasis patients explain to them the ointments that are to be restarted if the patch reappears. Applying the appropriate medication for the prescribed duration helps clear the skin. Once the skin has cleared, it must be kept regularly protected with a medicated moisturiser recommended by the physician.

Elderly individuals have reduced activity of oil glands in the skin, which leads to dryness even in the absence of skin disease. If such people suffer from psoriasis, the need for moisturisers becomes vital.

Friction with household utensils, briefcases, steering wheels, and badminton racquets or cricket bats are reasons for relapse of the disease. People who regularly handle these objects are advised to minimise the contact as far as possible. If friction actually occurs, the appropriate ointment should be applied on the area before retiring every night.

Stress and emotion

While attention to the patient’s general, physical and psychological health is always worthwhile, the emotional state plays a major role in keeping psoriasis under control. Many patients themselves observe that their condition relapses before major examinations or if there is a change in their job profile—situations of emotional upheaval.

Sleep disturbances and sustained anxiety leads to certain chemical changes in the body, and interference with the smooth functioning of the immune system, which is responsible for all repair processes of the human body. This in turn, exacerbates instances of psoriasis.

So, the affected person should be provided emotional support. Remember, though the disease looks bad, it is not contagious. And with love and support, it will be under control.

You may eat everything!

In the complicated and extensive forms of psoriasis, taking adequate rest and giving proper attention to meals helps speed up recovery. Diet has no specific role in the disease and hence the patient is free to eat whatever she likes.

Sex and intimacy

Young men and women suffering from extensive psoriasis suffer from deep anguish when the lesions are present on the trunk.

The shedding of scales in large amounts affects their marital life. It gives a creepy feeling not only to the person, but also her partner. Scaling in the genital areas makes intercourse embarrassing as there is intense anxiety of spreading the disease to the sexual partner. It would be worthwhile to repeat that the disease does not spread, even through sexual contact.

Using moisturisers or lubricants can help minimise the scaly appearance of the skin in these parts of the body.

Social issues

Most individuals suffering from chronic psoriasis would have already sought medical assistance from several doctors. The realisation of the fact that the disorder is chronic and recurrent, produces a lot of strain on the person’s mind.

Patients having extensive disease are often at the receiving end of dirty stares and comments from the public. When it affects the poorer sections of society, especially women, the social overtones can be extremely depressing.

When it comes to getting married, psoriasis patients find it difficult to find a life-partner even though the disease has no impact on reproduction or life expectancy because of the way the skin looks. The patches put off prospective mates.

Often, women find it difficult to select dresses that can conceal their patches on the skin. Going for a swim, visiting a beach or attending a party wearing sphagetti straps and shorts become impossible for women sufferers.

Brighter side

Psoriasis, with all its drawbacks, is a safe disease. Barring the small percentage of complicated cases, the internal organs are not affected, making life expectancy normal. The disease is not contagious and does not require repeated bandaging or dressing.

Even though psoriasis cannot be cured, with appropriate care, most patients have a disease-free interval of several years. The newer drugs help the patient lead a near-normal life and keep her gainfully employed and socially useful.

Maintaining adequate lubrication of the skin by using appropriate moisturisers is the mainstay of psoriasis treatment. When in doubt, moisturise!