Psoriasis: debilitating socially and emotionally

“Psoriasis is a predisposition for your immune system to react with your skin,” said Dr. Ellen Marmur, chief of the Division of Dermatologic and Cosmetic Surgery at Mount Sinai Hospital in New York City.

“Something that would normally… trigger a slight reaction in most of us, will trigger a domino effect in somebody with psoriasis.”

Beneath the surface, a psoriasis patient’s immune system overreacts and begins to attack itself. This abnormal activity is more characteristic of an autoimmune disease such as multiple sclerosis or rheumatoid arthritis.

Healthy skin regenertaes itself every 28 days but with psoriasis and as a result of inflammation, skin cells regenerate every two to four days, causing an excessive build up of cells.

When this happens, patches of the skin develop plaque, which is thick, red and scaly. The dead cells surface on top of irritated areas as loose, dry skin. They have a silver-white color and can flake off or crack. Depending on the type and severity, psoriasis can be painful and itchy.

In addition to the symptoms experienced, psoriasis patients who scratch their skin are likely to encounter or create further damage.

“If you scratch your skin, or if you have a piece of clothing that rubs against your skin in the area that is irritated, you can develop psoriasis. This is called the Koebner phenomenon,” said Dr. Mark Lebwohl, chairman of the Department of Dermatology at Mount Sinai School of Medicine and Mount Sinai Hospital.

Causes
Outbreaks are usually triggered by environmental factors like skin injuries; cold weather, infections, such as strep throat; bad reactions to medications; and even stress.

Psoriasis isn’t contagious. It can affect anyone and can plague anyone from babies to the elderly, Lebwohl said.

While some cases are so mild the patient doesn’t realise they have psoriasis, severe cases can be very debilitating and cover nearly the entire surface of the body.

The elbows, knees and scalp are the most common areas to be affected, however, psoriasis can present anywhere on the body, Marmur said.

Mild psoriasis is defined as 3 percent body coverage and severe psoriasis as 10 percent or more. Approximately 25 percent of those with psoriasis have a moderate or severe case.

There are a number of Types of Psoriasis
Where it turns up and how severe it is, has a lot to do with which of the five types of psoriasis you have.

1. Psoriasis vulgaris, also known as plaque psoriasis, is the most common, affecting more than 80 percent of all psoriasis patients. It can be a really well circumscribed pink, red plaque with a silvery or gray scale.

2. Guttate psoriasis is also red and scaly but smaller and typically covers larger body parts. It affects approximately 10 percent of psoriasis patients and can be triggered by strep throat.

3. Inverse psoriasis is red but doesn’t have the silvery-white scales. It presents as moist and red and covers smooth, creased areas of the skin like the armpits, the groin and underneath the breasts. Obese patients are most prone and tend to have more severe symptoms

A large portion of psoriasis patients are obese or become obese, said Lebwohl, who includes a heart-healthy diet as one course of action to improve your condition.

4. Pustular psoriasis looks like little spots of acne all over the body, Marmur said.

5. Erythrodermic psoriasis is the most severe form of the disease when plaque covers most of the body surface

Pustular and erythrodermic psoriasis are the rarest and the most dangerous. While they can occur independently, patients who develop them generally have plaque psoriasis. They are potentially fatal because they compromise the body’s ability to ward off infections and control body temperature.

“The typical story will be a patient with plaque psoriasis is given systemic steroids, cortisone,” Lebwohl said. “That clears psoriasis, but as you take them off of the steroids, you can develop a horrific flare where your body gets covered head to toe with red skin, or covered with puss pimples… Many of these patients will grow bacteria in their blood and can actually die from sepsis.”

Problems Associated With Psoriasis
Patients can become anemic from dangerously low amounts of protein in the blood, or suffer from other factors as a result of these debilitating forms of the disease.

When treating a psoriasis patient, doctors will ask a series of questions called the SF-36 to measure how it has impacted there lives.

In addition to its debilitating physical and psychological effects, psoriasis can force patients to miss work in order to manage their disease. Some of Lebwohl’s psoriasis patients have lost, or quit their jobs because of the amount of time they had to take off, he said. Others quit because of the embarrassment of not being able to perform.

“The National Psoriasis Foundation has looked at the incomes of patients and, basically, you can correlate income negatively with the various severities of the disease. The more severe, you’re going to earn less money,” said Lebwohl, who is also the chairman of the Medical Board of the National Psoriasis Foundation.

The disease is also linked to cardiovascular disease, diabetes and depression.

“Not only can it be debilitating socially and emotionally, but people with psoriasis also have a risk of other internal diseases,” Marmur said. “It’s like running your car at maximum, you’re just going to burn out other parts of the engine and infrastructure, other things are likely to premature wear or to be damaged.”

Dealing with the effects
Make sure you have been correctly diagnosed. Consult regularly with your doctor to ensure that you are receiving the best medical treatment. In addition to this, seek out local self help groups where you can share experiences and get practical advice. Keep up to date on the latest research but don't be the first one to try it.

Check what you are eating and try to establish living and healthy eating patterns, reducing your intake of artificial chemicals, sugar and caffeine. Also actively pursue activities which you enjoy and which relax you, give you a sense of well being. Learn to relax yourself through yoga, meditation or simply reading a book in a warm quiet room.

It is often difficult to mix well in groups and crowds because of the skin irritation but mainly because of the 'stigma' that makes you feel less worthy. Psoriasis and many other skin complaints do severely damage the self esteem and this leads to self isolation and exclusion from society. Seek out a good friend and ask for their help and support in keeping you socially active, simply by accompanying you to venues. To tell you the truth, we all do it, why not you?