It can be painful and is embarrassing. How does one tackle psoriasis?

All of us yearn for healthy, problem-free skin. But this remains a distant dream for many with psoriasis, a common skin disease characterised by scaly patches on the skin. The word is derived from the Greek psora, meaning itch.

Maya Vedamurthy, consultant dermatologist, Apollo Hospitals, says psoriasis is a chronic, stubborn skin disease characterised by silvery, scaly patches that can affect any part of the body.

A variety of causes seem to underlie the onset of psoriasis. Pointing to recent research, Murlidhar Rajagopalan, consultant dermatologist, Apollo Hospitals, says: “Psoriasis is considered to be a Type 1 autoimmune disease now. The white blood cells in the body mount an attack on the skin, and it thickens in response. The triggers for this are many, including stress, infections, dryness of the skin, alcohol, drugs such as beta blockers. How many of these triggers produce the changes they do, is not exactly known. But, many pathways have been uncovered to help us understand it better.”

Corroborates Dr. Maya: “Psoriasis primarily occurs due to genetic and environmental factors. The gene responsible for this susceptibility is PSORS 1.”

Often, infections in the body could act as a catalyst too. “Psoriasis is generally triggered by infections such as streptococcus. A subset of psoriasis known as guttate psoriasis, which affects children and young adults frequently, follows an upper respiratory tract infection, tonsillitis or pharyngitis. And, a sudden onset of psoriasis or exacerbation of pre-existing psoriasis has been found in patients with HIV.”

As with many new-age diseases, psoriasis is also directly related to one's lifestyle. “Stress is one of the most important factors in exacerbation of psoriasis. Diet has a bearing too, and obesity contributes to the onset and severity of psoriasis. Alcohol consumption is significantly associated with the extent of the infection, and smoking is a risk factor too,” says Dr. Maya.

Many manifestations

Psoriatic disease can present itself in different forms. Says Dr. Murlidhar: “There are many manifestations of the disease. It can be confined to the skin or affect the joints (psoriatic arthropathy); there are even metabolic issues associated with psoriasis —  diabetes, hypertension, lipid abnormalities, etc. Even in the skin, there are different types of psoriasis such as plaque psoriasis, generalised psoriasis, nail psoriasis and scalp psoriasis, based on the area and clinical features. Then, there is the life-threatening psoriatic erythroderma that affects the entire skin and requires hospitalisation.”

Is psoriasis contagious? “Psoriasis  is neither infectious nor contagious. But, what compounds the trauma for patients is dealing with the unsightly skin,” says Dr. Maya.

And so, patients  must be counselled to not worry about the unsightly rash, she says. The scales can disappear with proper medication; using moisturiser makes the scales look less obvious; and suitable clothing can conceal the affected area.

The other frustrating aspect for patients is the recurrent nature of psoriasis. Is there no cure? Explains Dr. Murlidhar: “Psoriasis typically recurs even after apparent cure. This is because the disease is basically immunological in nature and there are memory T cells that continue to circulate and get reactivated. Hence, follow-up is very important. The earlier a patient is treated, the better. Having said that, there is a pretty good chance of controlling the problem.”

Dr. Maya agrees, but says that  psoriasis, like diabetes, can only be controlled, not cured. However, she wants those affected to avoid going in for widely-advertised “quick cures”.

“Newer drugs ensure it is possible to achieve long-term remission. And, research involving newer drugs may hold promise for cure. Successful treatment depends on the age of onset, presence of family history, extent and site of involvement and severity of the disease. For, it is easier to treat a small localised patch than something widespread. Even in such cases, newer drugs such as biologicals help treat cases resistant to conventional therapy,” she adds.

Solution in hand

Avoid emotional stress

Weight reduction (if obese) and vegetarian diets help

Consume foods rich in anti-oxidants

Quit smoking and alcohol consumption

Keep skin moist

Treat infections promptly; seek treatment by an expert.