World Psoriasis Day 29th October 2013

For most of us, a hand-shake is a normal greeting; a passing moment that goes by virtually unnoticed. Holding hands is a natural expression of friendship and even love, something we take completely for granted. Going to the beach is an excitingoccasion. And wearing a little black dress is one of life’s pleasures.

But for the estimated 1 million South Africans suffering from psoriasis, these are all too often stressful, emotionally-wrought moments which tend to provoke instinctual withdrawal, adegree of shock, and the inevitable rubber-necking from people who simply don’t understand.

Psoriais is an inflammatory skin disease in which skin cells replicate at an extremely rapid rate. New skin cells are produced about eight times faster than normal – over several days instead of a month – but the rate at which old cells slough off is unchanged. This causes cells to build up on the skin’s surface, forming thick patches of red sores (or lesions) covered with flaky, silvery-white dead skin cells which are called scales.

Worldwide, about 125 million people are affected by psoriasis – that is 2% to 3% of the world’s population. Psoriasis occurs equally in males and females. Recent studies show that there may be an ethnic link. The incidence of the disease is more common in Caucasians and the highest prevalence psoriasis occurs in Scandinavia and other parts of northern Europe.

At its mildest, psoriasis can be itchy and sore. At its worst, it’s painful, disfiguring, and debilitating.It is very visible and unsightly. But it is not contagious.

Says Dr Mohamed Docrat, a dermatologist who specialises in the disease and runs a psoriasis treatmentclinic in Cape Town: “We don’t know the exact cause of psoriasis, but we do know that it is absolutely not transmitted by direct or indirect contact.”

Psoriasis has a strong genetic component but it is also thought to be an immunological condition because it occurs when the immune system sends out faulty signals that speed up the growth cycle of skin cells. It is triggered by a number of external factors, including stress, skin injury, and certain medicines.

In addition, a number of recent scientific reports have identified significant comorbidity between psoriasis and other life-threatening diseases including diabetes mellitus, heart disease, high cholesterol, obesity and hypertension. And it is estimated that about 15 percent of people with psoriasis also get psoriatic arthritis, which can be progressively disabling if untreated.

But Sister Judy Wallace, chairperson of the South African Psoriasis Association, stresses that by far the worst component of the disease is the psychological and emotional impact on patients. “People who don’t know any better see someone with psoriasis and assume that it’s a symptom of HIV, or even leprosy. There is a huge stigma attached, and people are scared that it’s contagious. As a result, many patients who suffer from this disease endure the added pain of discrimination in their communities,” she says.

“Many patients suffer in silence, they feel they can’t do normal things, they cover up their bodies at all times and hide away.”.

In a recent study conducted by the National Psoriasis Foundation, it was revealed that patients with psoriasis have a 39% increased risk of depression, a 31%increased risk of anxiety and a 44% increased risk of suicidailty. Patientswith severe psoriasis have a 72% increased risk of depression. As many as 60%of psoriasis patients report clinically significant psychiatric symptoms (such as depression) and may receive a psychiatric diagnosis.

The same survey found the over 80% of patients report their disease to be a moderate to large problem in their everyday life, while 25% report this disease negatively affects their job, almost one-third report that their psoriasis interferes with their sexual activity, and over 40% report experiencing social discrimination and humilation (e.g. being refused service at hair or nail salons, not being permitted to use public pools, gyms or health clubs), which contributes to feelings of shame and isolation.

“It’s heartbreaking, especially because there are treatment options that allow patients to manage the condition and live a normal life,” she says.

“Twenty years ago, there wasn’t a lot we could do for patients with psoriasis. But today, there is a whole range of treatments that allow patients to engage in a completely normal life,” he says.

In terms of treatment protocols, the South African guidelines on the management of psoriasis recommend first-line treatment by topical products. If first-line treatments fail, there are several other options for patients to explore, including phototherapy which involves the application of ultraviolet light to the affected areas, systemic medications that can be taken orally or by means of an injection, and now even biologic drugs that are prescribed for more severe psoriasis and psoriatic arthritis that has not responded to other treatments.

“It’s important to remember that while this disease is chronic and requires lifelong management, it can be managed,” says Dr Docrat.

Sister Wallace agrees adds too that one of the best ways to manage this disease is to join a communitythat understands. “The South African Psoriasis Association (www.psoriasis.org) aims to help psoriasis sufferers in South Africa, however we can,” she says.

Most importantly, says Sister Wallace, it encourages people suffering from psoriasis to come out of hiding. “They shouldn’t have to hide anymore,” she says.

Psoriasis: The Facts

– Psoriasis is an inflammatory skin disease in which skin cells replicate at an extremely rapid rate. New skin cells are produced about eight times faster than normal – over several days instead of a month – but the rate at which old cells slough off is unchanged. This causes cells to build up on the skin’s surface, forming thick patches, or plaques, of red sores (lesions) covered with flaky, silvery-white dead skin cells (scales).

– The plaques of psoriasis occur most frequently on the elbows, knees, other parts of the legs, scalp, back, face, palms, and soles of the feet. Psoriasis can also affect the fingernails and toenails, causing pitting, discoloration, or tissue buildup around the nails.

– At its mildest, psoriasis can be itchy and sore. At its worst, it’s painful, disfiguring, and debilitating.

– Worldwide, about 125 million people are affected by psoriasis – that is 2% to 3% of the world population. Although there are no official statistics in South Africa, the South African Psoriasis Association estimates that approximately 1 million people are affected locally.

– Psoriasiscan affect people at any age, but it most often strikes those between 15 and 35 years old. Approximately one-third of those who get psoriasis are under 20 years old when the disease first surfaces.

– Psoriasis is not contagious, but it can be unsightly. As a result, psoriasis impacts patients both emotionally and socially. People with psoriasis are twice as likely to suffer from depression as the rest of society.

– Psoriasis does have a genetic component, with 71% of children affected by psoriasis showing a strong family history of the disease.

– Although scientists have not identified the exact cause of the disease, they believe that it develops when someone who has inherited the gene is exposed to a specific external factorknown as a trigger. Common triggers include stress, skin injury, and medications such as lithium, certain anti-malarials, inderal, quinidine and indomethacin.

– There are five types of psoriasis: plaque psoriasis, guttate psoriasis, inverse psoriasis, pustular psoriasis and erythrodermic psoriasis. Plaque psoriasis is the most common form of the disease, while erythrodermic psoriasis is the only form of the disease that can be life threatening.

– Research continues to show a link between psoriasis and several other serious health conditions. For example,patients with psoriasis have an increased risk of developing cardiovasculardisease, diabetes and depression. And about 30 percent of people with psoriasis develop psoriatic arthritis.

– There is no known cure for psoriasis; it is a chronic condition. Although the symptoms may subside for a while, they tend to flare up later. Remission can last for years in some people; in others, flare-ups occur every few weeks.

– There are a variety of treatment options for patients suffering from Psoriasis, which can be classified into four categories: topical treatments that are applied to the skin, phototherapy (which is the application of ultraviolet light), systemic medications that can be taken orally or by means of injection, andbiologic drugs that are prescribed for more severe Psoriasis and Psoriatic Arthritis that has not responded to other treatments.

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