Psoriasis, a troublesome skin condition can be controlled  |  Photo Credit: iStock Images
New Delhi: Psoriasis is a skin condition in which skin cells build up forming a red and flaky rash. The month of August is observed as Psoriasis Awareness Month, dedicated to educate and inform people so as to clear their misconceptions about this troubling skin condition.
Psoriasis is an autoimmune condition, the exact cause of which is not yet known. Genetic factors may play a role and some patients have a family history of the condition. The symptoms include redness and thickening, scaling and flaking, itching of the skin. It may also be painful. As compared to a normal renewal of skin cells that happens in 40-45 days, it takes just 5-6 days in psoriasis patients leading to thickening of the skin. The symptoms may fluctuate in severity, subsiding at times and aggravated by certain factors like change in the climate, stress, etc.
One should also remember that it is not just a skin rash, but also a systemic condition as the inflammation in the skin may also be present in the joints and other parts of the body. This results in psoriasis being accompanied by other conditions that have a major effect on the quality of life of patients. As the effects are visible, patients often are at the receiving end of social stigma and discrimination due to the misconception that it is infectious or contagious. This can lead to anxiety and depression in patients. Patients are also at higher risk of developing other co-morbidities such as obesity, diabetes, psoriatic arthritis, heart disease and hypertension, and inflammatory bowel disease.
Worldwide, over 125 million people are affected by psoriasis. More than 1/3rd of the patients have moderate to severe symptoms. In 2014, the WHO recognized psoriasis as a serious NCD (non-communicable disease).
A chronic skin condition, ‘control’ rather than ‘cure’ is the approach taken to provide relief from the symptoms and improve the quality of life. Psoriasis is a multisystem condition requires a multisystem approach.
Treatment includes topical treatment for the skin to slow down the skin cells from growing rapidly and remove the scales. This can be achieved through topical treatment with steroidal and non-steroidal creams or lotions, coal-tar or salicylic acid based creams and gels for the scalp, and moisturizers. Synthetic forms of vitamin D, such as calcitriol are also used in conjunction as they help to slow the skin cell growth. Retinoids are used to reduce inflammation and build-up of plaque. Light therapy with UVB broadband and narrowband treatment; PUVA therapy, that is, psoralen, a light sensitizing medication with UVA light; excimer laser therapy are other topical treatment options that help in controlling the skin inflammation.
Oral and injected medications are used in cases of moderate to severe psoriasis. These include steroids, retinoid, and immuno-modulator that decreases skin cell production and suppresses inflammation. In difficult cases that do not respond to any other line of treatment, biologicals that alter the immune system and improve symptoms and signs of disease can be of great help.
While medical treatment is the mainstay, managing one’s lifestyle is also important. Controlling stress, one of the main triggers is beneficial. Living a healthy lifestyle with proper diet, physical exercise, avoiding tobacco and alcohol, all help in reducing stress and in controlling the condition.
This is a time when the entire focus is on the COVID-19 pandemic. Many patients are worried about the relation between psoriasis and COVID. While there is no direct correlation, the immuno-modulators and immuno-suppressants a patient is taking may alter the immunity and patients on these medications should take proper precautions to avoid infection, as infection may result in a slightly severe form.
Therefore, with proper management, the condition can be controlled to ensure a good quality of life for patients.