- NEWSDAY.CO.TT - A la Une - 05/Aug 07:45

Understanding the pain of psoriasis

BAVINA SOOKDEO AUGUST marks Psoriasis Awareness Month and consultant dermatologist in private practice, Dr Marilyn Suite told Newsday that psoriasis is estimated to affect about two per cent of the world’s population. Suite explained that psoriasis is an inflammatory condition caused by the rapid multiplication of skin cells and is believed to be autoimmune in nature. “The body’s immune system starts to be ‘overactive’ in the skin and often the joints as well,” she said. She added that psoriasis also has a genetic basis, noting, “You are more likely to have psoriasis if one of your parents has it.” Importantly, she clarified that it is not an infection and cannot be spread from person to person. According to Suite, public awareness remains low. “The general public perhaps is unaware of psoriasis and one of the first questions I am asked after making the diagnosis is, ‘How did I get this, doctor?’” she said. “They should be assured that it is not something they ‘caught’ but it is a genetic tendency.” When asked about the prevalence of psoriasis in Trinidad and Tobago, Suite explained that while exact national figures are unavailable, one study found that approximately five per cent of new patients seen at the dermatology clinic at Port of Spain General Hospital during the study period had psoriasis. The doctor pointed out that the condition affects any age group including children. In TT, it appears to affect persons of East Indian descent more than those of African descent and men are more often affected than women. As for the diagnosis of psoriasis, Suite explained that it “is usually easily made if the rash presents in its typical way but sometimes a skin biopsy may be needed to confirm the diagnosis.” Types of psoriasis Suite also outlined the different types of psoriasis and how they present. “The most common type of psoriasis is called plaque psoriasis,” she said. “This presents as thick, scaly raised areas of skin (plaques) that may be red in colour, but in darker skins, may be shades of brown, brownish-red or gray. The scales are often silvery or white. The rash may not be itchy but most people experience itching of varying intensity.” She added that plaques, when very inflamed, can become painful and may bleed. “When the lesions heal, they may leave discoloured spots that take some time to fade,” Suite explained adding that any part of the skin may be involved, including palms and soles as well as the scalp and nails. She described guttate psoriasis (the word ‘gutta’ is Latin for drop) as presenting as small, drop-like spots that may appear suddenly, often after a throat infection. “It is seen mainly in younger patients and tends to clear quickly with treatment,” noting that those patients may go on to develop classical plaque psoriasis later in life. [caption id="attachment_1170314" align="alignnone" width="683"] Psoriasis is estimated to affect about two per cent of the world’s population. -[/caption] She pointed out that psoriasis may also show up in areas like the underarms, groin and beneath the breasts in a form called inverse or flexural psoriasis, which appears as flat, red or brown, shiny with well-marked out edges. Another type, pustular psoriasis, involves tiny pus-filled blisters that may affect only the hands and feet or may become generalised. Psoriasis may rapidly involve the entire skin with generalised redness, scaling and soreness. “This is called erythrodermic psoriasis and patients may be very ill with fever and chills,” explained Suite. “They may lose a lot of fluid through the skin and become dehydrated. This situation requires hospitalisation” she emphasised. Physical and emotional challenges The doctor added that joints are affected in about 30 per cent of psoriasis cases. “While the skin rash usually presents first, some persons may have joint involvement before the rash appears. The joints become swollen and painful and if untreated, may later develop deformities.” In addition to the physical symptoms, Suite highlighted the significant emotional and lifestyle challenges that people with psoriasis often face. “Like any chronic disease, psoriasis can impact quality of life depending on its severity and the areas of the body that are affected – although even mild psoriasis may be distressing.” Itching and pain, or the thick scaling that can occur may hamper daily activities, work, school, social interaction and relationships. Joint pain or disability may further limit mobility or the ability to handle certain tasks. Suite added that individuals may experience “stigmatisation and embarrassment because of the appearance of the skin and they may be less likely to be employed in certain occupations.” Asked if there are any lifestyle factors or triggers that can worsen symptoms of psoriasis, the seasoned dermatologist explained that psoriasis is now recognised as a multisystem disease. “This means that there is an association with changes in other organs apart from the skin and joints” she said. People with psoriasis are more likely to have cardiovascular disease including heart attacks and strokes, high blood pressure, high lipid levels (cholesterol and triglycerides), diabetes and are more likely to be overweight or obese. “It is therefore necessary to try to control these factors by adopting a healthy lifestyle which includes exercise and a healthy diet,” she advised. Suite further noted that stress is another significant trigger. “Stress can worsen psoriasis,” she said, adding that living with the condition can itself lead to anxiety, depression, and in some cases, even thoughts of suicide. Managing emotional well-being is therefore a vital part of overall care. “Psoriasis tends to occur at the site of injury of the skin” she noted, “so it may develop in cuts or bruises or surgical scars.” Heavy alcohol intake and smoking are also believed to be triggers for psoriasis. Some of the drugs that may provoke psoriasis include lithium (a psychiatric drug), antimalarials and some high blood pressure drugs. Available treatment When it comes to treatment, Suite said most cases of psoriasis of the skin are treated with steroid creams or ointments, prescribed based on the patient’s age and the location of the rash. “These reduce inflammation and stop the skin cells from multiplying rapidly and should be used under a doctor’s supervision. “Oral or intramuscular injected steroids should be avoided because while psoriasis may clear quickly, the patient could experience rebound or worsening of the psoriasis and may develop pustular or erythrodermic psoriasis.” The doctor related that calcipotriene or calcipotriol ointment, which is derived from vitamin D, was developed specially for psoriasis but it is no longer available in TT. However, she noted that other drugs called retinoids and calcineurin inhibitors are also used and are available. “Salicylic acid and coal tar are older ointments which are still useful to help thick plaques. Dithranol cream or ointment is not available locally but is used a lot in the UK,” she said. She advised that if psoriasis is unresponsive to topical treatments and is extensive, the person should be referred to a dermatologist. “The dermatologist is likely to prescribe treatments by mouth or by injection,” Suite stated adding that they include drugs like methotrexate, cyclosporine, retinoids (vitamin A derivatives) and the newer injectable biologic drugs such as infliximab, etanercept, adalimumab, ustekinumab, guselkumab and several others. “The biologic drugs are expensive and are not usually the first line of treatment, but they are available in TT, some are available at public hospitals.” She hopes they will become cheaper in time so that all patients with severe or unresponsive psoriasis can benefit. The doctor added that natural sunlight can help psoriasis provided the individual does not get sunburnt. Relating that light treatment in the form of PUVA (oral psoralen and ultraviolet A) and narrow band UVB (ultraviolet B) can be used with or without oral treatments, Suite added, “Excimer laser is used to treat specific lesions since it targets smaller areas. Some local dermatology clinics in the private sector have these modalities. Broadband UVA is also used.” So is psoriasis curable? As Suite explained, “Psoriasis is a life-long condition which is subject to relapses. It is treatable but not curable and requires the patient to be compliant and follow up with his/her doctor.” However, there is hope. “One can live an active, normal life and one may prevent flares by adopting a healthy lifestyle, controlling the comorbidities described above and managing stress,” Suite advised.   The post Understanding the pain of psoriasis appeared first on Trinidad and Tobago Newsday.