Psoriasis: Scaly, not scary condition

It can be controlled with medication. However, the condition brings with it social discrimination, largely due to the nature of the disease and the physical appearance.

With scaly skin either in the scalp or in the knees or elbows, psoriasis, can be extremely chronic for some, with scaling all over the body. It is characterised by plaques of red skin - these lesions may be itchy and painful - which tend to crack and bleed. Sometimes, the affected skins merge and grow, covering large areas. The symptoms are discolouration and chipping of the nails. 

Dr M Manimegalai, Professor of Dermatology at Government Stanley Medical College Hospital, says that the prevalence is high, given the number of cases she gets to see  in her practise. “In most of these cases, there is family history at play,” she says. 

Other reasons include stress or major surgeries that are precipitative, she adds. “A majority of the cases are seen in the adult age group and both men and women could get affected,” she says. With scalp lesions in some cases, doctors say that it is often mistaken for dandruff. They add that in some cases, it occurs in hidden areas like inner ears, under the breasts, umbilicus or in the anal region.

A distressing disease, it can be controlled through a combination of medications—including topical ones and mild steroids, to systemic treatment including methosulphate and phototherapy. Effective medication can lead to remission and the person can lead a normal life, adhering strictly to medical advice and frequent follow up on the progress, points out Dr Manimegalai. 

“But it becomes difficult to give effective therapy when some people tend to mix up different kinds of medicine — allopathy and alternative - hoping to get quick and effective results. “These could lead to serious complications with very little scope for remission,” she points out. 

Among 100 people afflicted with the condition, experts tend see as many as 9 to 10 per cent with psoriatic arthritis, says Dr N Thilagavathi, consultant rheumatologist, SIMS Hospital. Those with joint pains - ranging from small to bigger joints and even the spine — are referred by dermatologists to other specialists. “This group needs immunosuppression and we have a very effective treatment for them in the form of biologics. This condition cannot be just observed, but needs immediate treatment. It is a mutilating disease, resulting in bone erosion and deformities,” she says. 

A recent survey titled ‘Clear About Psoriasis’ that surveyed over 8,000 respondents from 31 countries including India revealed that there is widespread discrimination against those with the condition. Psoriasis patients numbering 215, and hailing from many states including  Tamil Nadu, were among the 8,000 respondents.  The findings revealed that a whopping 40 per cent said  that because of their medical condition, they were often being stared at in public. 

Other findings included that in India 18 per cent of people with psoriasis have been asked if they are contagious. About 36 per cent admitted to feeling embarrassed about their appearance and skin and 48 per cent of the patients interviewed shared that psoriasis has impacted their professional life. 

Around 30 per cent of them feel that psoriasis has impacted past or current relationships. Dr Thilagavathi said, “The widespread discrimination and embarrassment are  evident from the fact that most of them cover up themselves to avoid any attention, even during hottest of summers. The discolouration and scaling leave them with very low self-esteem,” she said.