This year’s theme for World Psoriasis Day observed was ‘Access for all’. Dermatologists treating psoriasis say lack of awareness about the condition and treatment leads to stigmatisation, even pushing people to consider ending their lives.
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Psoriasis is an autoimmune disease that manifests as rashes usually on the face, elbows, knees and later spreads across the skin. There are many kinds of psoriasis and among them, the most common is psoriasis vulgaris. But there are also severe manifestations, leaving patients bedridden or with gnarled fingers. The condition could be inherited, as in the case of V. Harish, 56, who was first diagnosed with arthritic psoriasis 15 years ago. He is among the 30% of patients who have joint involvements.
He underwent physiotherapy to stem further damage to his gnarled fingers. “My father also had psoriatic arthritis. Your lifestyle, food habits matter. I can tell you stress is a solid trigger,” he said. Post-retirement he invested heavily in a cooperative bank in Bengaluru which later declared bankruptcy. The stressful situation triggered a relapse, Mr. Harish recalled.
“People will not talk to me easily. They will avoid sitting with me at the same table during lunch. They think I have skin cancer as there are red patches on my face and hands.”G. Arun Kumar, 32-year-old patient
“The medication is very expensive, but I was covered under group insurance. I had to take injections costing ₹35,000 every fortnight. I needed seven to eight doses before I could function reasonably. I am on tablets now but over the years we become resistant to medicines and the condition relapses,” said Mr. Harish, among the lucky few whose family stood by him even when he was bed-ridden.
For 32-year-old G. Arun Kumar, who was diagnosed nearly three years ago, it has been a struggle. “People will not talk to me easily. They will avoid sitting with me at the same table during lunch. They think I have skin cancer as there are red patches on my face and hands,” he said. His mother died of COVID-19 in April 2021 and in October of that year, he was diagnosed with psoriasis. Medication has controlled the spread. Ever since he began cooking his food at home he has better control over his condition. “For the past three months, I have started cooking and it has helped as I don’t eat outside. A fever or stress aggravates the disease,” he added.
Muralidhar Rajagopalan, senior consultant dermatologist at Apollo Hospitals, Chennai says the non-communicable autoimmune disease occurs due to inflammation as the body attacks the skin through various mediators, for various reasons. “The lifestyle-induced disease can be mitigated by exercise and controlling obesity. Alcohol and smoking worsen psoriasis,” he said. “Change in lifestyle in our country could be a reason cases are increasing. Increased awareness has resulted in more patients seeking help.”
Psoriasis is mediated by signals of inflammation exchanged by cells called interleukins and cytokines. Abdominal fat produces adipokines, interleukin 6 and TNF alpha, all of which adversely affect the outcome of psoriasis. “Losing this fat and maintaining ideal weight is vital. I advise exercise and diet control, low carb diet, avoiding sugar and dairy foods,” Dr. Muralidhar said.
Psoriasis is also linked to cardiovascular events, as certain cytokines and TNF alpha affect blood vessels producing atherosclerotic blocks. “Patients are prone to diabetes, abnormal lipids and hypertension adds to it. Many of them are unable to exercise. More aggressive inflammation worsens the risk of all associated morbid events,” added Dr. Muralidhar who represents the International Psoriasis Council in India.
In developed countries insurance covers treatment for severe psoriasis whereas in India it is still regarded as a cosmetic disease, the exception being joint involvement. “A proper disease registry, making psoriasis reportable and mentioning associated disabilities will help,” he pointed out.
M. Girish, former head of Skin and STD in Rajaji Nagar ESIC in Bengaluru, explained that the epidermis has five layers and it takes 40 to 50 days to complete a cycle for dead cells to be replaced. In psoriatic patients, it is reduced to 10 days. Recently transferred to Kerala, he said 10% of the patients he sees have psoriasis. Generally, more men than women have the condition with 15-20% chances of an offspring contracting it, if one parent is affected. “Psoriasis worsens in winter and many medications can trigger or induce psoriasis,” he said.
Sonia Feroz, director and consultant dermatologist at Serene Derma in Thiruvananthapuram, explained that psoriasis is a disease spectrum whose treatment cost could depend on the stage and type of disease. “The common manifestation is a simple form, but it is a complex reaction between your innate immunity and adapted immunity. There are some triggers – smoking, alcohol, drugs, vaccination... if you are playing with your immunity, they could induce psoriasis,” she cautioned.