World Psoriasis Day 2021: Psoriasis is a skin disease that causes red, itchy scaly patches, most commonly on the knees, elbows, trunk and scalp, but its impact is not limited to just skin but can extend to other organs of the body as well. Psoriasis can worsen diabetes, cause heart disease, liver problems and high blood pressure. Due to the stigma attached to the disease and the disability that may come with it, many people are at risk of developing depression while battling the disease.
“Psoriasis affects 2-3 % of the world and while the exact incidence in India is not known, we expect it shouldn’t be any different from the rest of the world. Maybe around 2% of the Indians are also affected by Psoriasis,” says Dr. Murlidhar Rajagopalan, Dermatologist, Apollo hospital, Chennai in a telephonic interaction with HT Digital.
Cause of Psoriasis
Psoriasis is an autoimmune disease which means the body for some unknown reason, presumably genetic reason, works against its own skin. The skin reacts by producing thickened patches.
“In this disease, the immune system is the one that affects the skin. When you look at how psoriasis presents, there can be one patch or patches all over the body. Psoriasis can also produce very severe forms in which the patient may come from head to toe with a red skin,” says Dr Rajagopalan.
There are different kinds of psoriasis on the basis of organs it affects and the degree of severity of the disease.
“The other thing that is fortunately not very common is pustular psoriasis. The whole skin will be filled with lakes of pus. Actually, this pus is not an infection, it is the body’s own immune cells which have got collected as lakes under the skin. It is just a severity of the inflammation that produces pustular psoriasis,” says Dr Rajagopalan.
Myths about Psoriasis busted by Dr Rajagopalan
Myth 1: Psoriasis is limited to skin
Fact: Psoriasis is not something which is limited to the skin. The same immune system that is causing all the damage to the skin is affecting other organs of the body also.
“Very often when we work on patients with psoriasis we find that they have an abnormal liver or they have diabetes or they have high blood pressure or they are prone for cardiac attacks which we call major adverse cardiac events or even stroke.
Most people think that this disease is just on the outer surface of the skin. When I say most people, it includes dermatologists and doctors also. If people are not well-informed they will think that this is just something on the skin and the treatment will be suboptimal or the patient won’t get maximum possible treatment that he/she requires,” says Dr Rajagopalan.
Myth 2: Psoriasis can infect others or can be passed on to children
Fact: “Marriages have got dissolved due to psoriasis. Women sometimes can’t find a boy who would like to marry them because of these myths and misconceptions about psoriasis.
The most common misconception of psoriasis is that it can’t be controlled or it is going to infect somebody else. The big misconception is that if a girl with psoriasis marries, her kids too will have the disease. It is not necessarily true. The percentage of women whose kids have psoriasis is only 2% which is almost equal to the prevalence in the normal population,” says the expert.
Myth 3: Treating psoriasis is expensive
Fact: People sometimes think that treating psoriasis is expensive because it’s a long-term treatment and there is no promised cure for psoriasis. The effect on the quality of life is more expensive than having the disease. This is why doctors should explain cost benefit ratio to patients.
“Now in this, a tool called econometrics can be used —we are looking at the ability of a person to work. If psoriasis affects hands and soles, we cannot practically work, if it affects the joints which we call psoriatic arthropathy – where the joints usually the small joints are affected – people cannot do fine work. The percentage of psoriatic arthritis is almost 30% in patients with psoriasis which is a large number. So that can limit the livelihood of a patient and then it can affect the spine too . When psoriasis affects spine, it is very painful as patient may get bed ridden. The magnitude of what psoriasis can actually do is somehow being missed out. So, leaving psoriasis untreated is more expensive,” says Dr Rajagopalan.
Can Psoriasis be treated?
While psoriasis cannot be cured,there are targeted treatments that show good promise. These treatments target the particular pathway in the immune system which is worsening the disease.
“While in earlier days, we could clear only about 20% of the skin, now we are getting 100% clearance rate which directly translates into suppression of immune imbalance. Immune system is also being restored to normal and it is becoming possible to prevent comorbidities like cardiac problems,” says Dr Rajagopalan
“So it’s not like old days when one either had to apply cream or get covered with tar from head to toe, taking off all clothes and stand in sunlight,” adds the doctor.
Can a cure to psoriasis be found in future?
“Now we are looking at what are the biomarkers. These are the mediators in the blood or skin or tests that we can do to find out which pathway is more prominent and target it in a particular patient. You can predict response to a particular drug, safety, toxicity etc. That’s the way research is going on. Four years down the line, they will also go into genetics that what is stimulating the immune system to misbehave and probably modify that so that you get a permanent cure. We are slowly going towards a cure for psoriasis,” concludes Dr Rajagopalan.