Arshad, 40, was getting miserable from itching and inflamed skin patches that were spreading on his body. He had scales that were itchy. And was restless if he did not scratch them. His face was also affected and it remained inflamed all the time. All this was embarrassing for him therefore he hesitated to meet people. Arshad had psoriasis.
According to Dr Kalsoom Rizwan, a dermatologist at DHQ hospital Faisalabad,“skin disorders which affect an individual’s looks can cause depression, stress and low self-esteem”. Psoriasis is one such disease.
It is an auto immune disease in which the immune system reacts with skin cells and causes them to grow excessively. Explaining the mechanism she says, “T cells are type of white blood cells which are soldiers of the body and fight against disease and infection. They become overactive and start producing extra skin cells.” So, the upper layer of skin (epidermal) is replaced in three to five days, instead of normal 28 to 30 days. Extra skin cells form silver scales and dry red patches. “Psoriasis can be mild, localized to certain spots, or can be severe and spread to the entire body.”
Research is still going on to find out the causes of psoriasis but so far, studies have revealed that genetic factors are responsible for it. “Other than genes, environmental factors can also trigger the problem,” says Dr Kalsoom. For instance, trauma, heat, severe sunburn, smoking, skin dryness, recurrent infections, stress, obesity and cold weather. “Certain medicines of high blood pressure and anti-malarial drugs can also serve as triggers,” she adds.
Psoriasis symptoms include itching, swelling, pain, fever, muscle aches, red tender skin and nausea.
There are many types of psoriasis. The most common type is plaque psoriasis. “Red inflamed patches with white scales on shin, scalp, belly button, elbows and knees are common symptoms of this type.” Guttate psoriasis is one in which drop shaped lesions cover large areas of the body. In inverse psoriasis skin folds and genitals become covered with smooth red patches of inflamed skin. In pustular psoriasis mostly hands and feet are filled with small noninfectious pus filled blisters. In erythrodermic, rashes are widespread and fingernails and toe nails are also affected. It is fatal because it badly affects the regulating ability of skin. In nail psoriasis, nails become brittle and discolored, and separate from nail bed. “Scalp psoriasis is also common. It can be reduced to a small area or can cover full scalp extending to forehead and neck.” Dandruff and hair fall with severe itching makes it really upsetting. Patient feels like scratching his skull. “Antidandruff and moisturizing shampoos can provide a bit relief but not permanent cure.” Psoriatic arthritis is a highly painful condition in which inflammation of skin is accompanied with inflammation of joints. “The situation becomes worse when inflammation reaches to spine, tendons and cartilage, causing disability,” explains Dr Kalsoom.
Diagnosis of psoriasis is done by examining the skin appearance. There is no special diagnostic procedure or blood test. However, sometimes biopsy is performed to find out the type and severity.
Unfortunately, there is no cure for psoriasis. It can be treated by controlling the symptoms and managing them well. According to Dr Kalsoom, controlling psoriasis focuses on removing scales, smoothing skin and slowing cell growth. “Mild to moderate psoriasis can be managed easily by certain creams.” There are steroid based creams, vitamin D creams and other topical applications, which work by suppressing the immune system. Steroids however, have lots of side effects. “They cause thinning of skin and increase resistance against treatment. So try to avoid steroid based creams and medicines,” says Dr Kalsoom. Biologics are medicines which slow down cell growth and inflammation by blocking the immune responses. “They carry serious side effects because blocking immune system means inviting multiple infections.”
Other than this, phototherapy is a treatment done by ultraviolet rays of sun or special lamps. Overactive T cells slow down in the sun. “Controlled ultraviolet exposure by dermatologist is a better option instead of sitting directly in sun, because sun exposure can always cause skin issues like, dryness and skin cancer.” Laser treatment to retard cell growth is also effective. For severe psoriasis topical creams are combined with medicine and phototherapy and this is called photo chemotherapy.
Discussing the management of the skin disorder further, Dr Kalsoom recommends using lubricants and ointments which provide soothing effect by sealing water in the skin and thus preventing itching and scaling.
“Bathing daily especially with dead sea salt or Epsom salt helps in removing scales,” she says. Soaking your body in water for a few minutes also helps in removing scales and decreasing inflammation. Moisturizing skin immediately after bathing with olive oil or petroleum jelly prevents dryness. “Dryness always increases itches and rashes.”Avoid using hot water, instead always use lukewarm water. Keeping a humidifier in room also prevents dryness and itching. “Use soaps and moisturizers without dyes and perfumes because they can cause further inflammation to psoriatic skin.”
Social life of a psoriasis patient is badly affected, especially his intimate relations. Affected hands and feet interfere with job and household work. This discomfort and disability leads towards serious psychological issues. Flare ups and itching badly effect sleep of a patient.
Psoriasis is an unpredictable condition. One treatment may work for one patient but not for other. Moreover, there are episodes of remission and sudden flare ups. It is important for patient to get the right information about his disease. He must find out what provides trigger to flare ups and avoid it. Diet also plays a role. “Avoid spicy food. Eliminate red meat and fatty foods from your diet. High fiber foods and fruits help. Being stress free and exercising daily also helps to prevent flare ups,” says Dr Kalsoom.
The writer is a freelancer based in Faisalabad