My dermatologist says that I have psoriasis. What causes it?
Psoriasis is a common skin condition, which affects about 2 to 3 per cent of the world’s population. We believe there is a genetic component in development of the condition, though it can be triggered by environmental conditions like stress and depression. Certain medications can also trigger psoriasis for example beta blockers (used in treating high blood pressure and angina), lithium and some anti-malarial drugs. Under normal circumstances, it takes 28 days for skin cells to shed. However, in psoriasis, the skin cells shed too quickly – around seven days. This happens because the immune system malfunctions and begins to attack itself by targeting skin cells. The immune system is normally supposed to defend us and fight infections caused by bacteria and viruses.
Does it affect just the skin?
Psoriasis affects not only the skin, but nails and joints as well. The skin cells are produced too quickly resulting in the development of red, scaly patches of skin which may be itchy.
Is it like eczema?
Most people confuse psoriasis with eczema. While eczema causes intense itching, with psoriasis the itch is not so severe. Psoriasis is not an infectious disease – it cannot be passed to someone else by touching them, neither does it result in cancer. A lot of people confuse the skin condition with cancer. Anyone who develops a skin problem, should visit a specialist for the right diagnosis and management of the condition.
Who is at risk?
Generally, psoriasis affects people between the ages of 15 and 35. However, psoriasis can develop in younger or older age groups. It rarely affects infants and affects men and women almost equally. It usually develops at the age of 15 but in 10 per cent of the affected, the symptoms begin before the 10th birthday. One will notice areas of skin becoming inflamed, and red, scaly bumps will begin to appear on the skin. The rashes may start over a small area of skin and then progress.
Sometimes it causes thick scales along the hairline. 50 per cent of patients with psoriasis suffer this. Different topical treatments and shampoos are available to manage scalp psoriasis.
How is it managed on a day to day basis?
The condition is known to have a genetic component and is an autoimmune condition.
A patient should be examined by a general practitioner or dermatologist. A specialist will conduct a thorough physical examination and make a clinical diagnosis in order to devise an appropriate treatment plan.
The skin is managed with medicines and we also encourage management of stress, cessation of smoking, avoidance of excessive use of alcohol as these are all triggers. Excessive sunlight can also be harmful.
Basically, management is through lifestyle change. If someone is overweight, they need to shed some weight and eat a healthy balanced diet.
Treatment options include medications ranging from moisturisers to other topical preparation. These all help to relieve the symptoms.
Is it curable?
Unfortunately, there is no cure for psoriasis but it is a manageable condition. When the skin is properly managed, it appears normal. We have a range of medication to calm down the immune system. They vary depending on the severity of the psoriasis.
· Topical treatments. These are emollients, topical steroid applications, coal tar and other topical immunomodulators.
· Phototherapy. This is a type of light treatment where ultraviolet light is delivered to the skin in a controlled way. This requires the patient to visit the phototherapy unit at a hospital. Treatment is administered two to three times a week for eight to ten weeks.
· Systemic treatment. In more severe cases or if the nails and joints are affected, oral or injectable medication can be administered to moderate the immune system. For proper management, rheumatologist may also examine patients who have developed joint complications such as psoriatic arthritis.
Is there a confirmatory test?
Clinical diagnosis is done to confirm psoriasis. A skin biopsy is also done, where part of the skin is removed and examined under a microscope.
Your dermatologist will also perform blood tests to check if you have any other co-existing conditions such as diabetes, high cholesterol, high blood pressure or heart disease. This condition is associated with high cholesterol levels, diabetes and heart conditions. People are therefore encouraged to live a healthy life.
As told to Mercy Kahenda