Hope, at last, for the condition called psoriasis

MANILA, Philippines - When Steph first noticed the red, scaly, thickened irregular map-like areas on the skin on her back and chest, and later on her extremities, she felt dismayed.

Aghast. Surprised. She was very confident that she took good care of herself — eating the right food, bathing at least twice a day, keeping the right company. She had no vices. She did not smoke, although she often had late night meeting with clients and beating deadlines. 

As a young advertising executive, she frequently had hearty buffet dinners and good wine to cap each meal. It was a comfortable life that since a year ago had been marred by the repeated appearance of this skin problem whose name she did not know. She felt unclean, unsightly and embarrassed to be seen the way she was.

The most natural thing to do — and a wise move as she sees now — was to see a dermatologist. It was good that she opted to see a skin specialist, instead of simply relying on the medications that well-meaning friends passed on to her. The dermatologist enlightened her about the disease she suffered from.

Psoriasis. That’s what it is called, Dr. Irene Gardiner of LEO Pharma said. While it had nothing to do with her hygiene and grooming regimens, her episodes may have been triggered by her alcohol intake and the stress related to her late nights and busy schedule. 

A non-contagious disorder, psoriasis is a chronic (long-playing), autoimmune condition that is thought to affect one to three percent of the population. While many patients have a family history of the disease, some simply develop it.

The problem begins with defective signals in the skin’s immune system, resulting in what is known as increased skin cell turnover. In normal persons, for example, new skin is produced, replaced and sloughed off in 28-30 day cycle; in persons with psoriasis, new skin cells are made in three to five days — even when the ones preceding them have not been shed.  This results in the accumulation on visible skin surface of thickened plaques (the map-like areas) with silvery scales. The inflammatory process associated with psoriasis gives the distinct redness of the plaques that are characteristic of the disease.

According to Gardiner, there is no absolute cure for psoriasis. Patients will, time and again, experience recurrences; these, fortunately can be controlled.

The first line of treatment involves the use of topical agents, or medications applied on the skin — the most popular of which are the topical steroids.  Designed to decrease the redness and thickness of the skin, this type of treatment is best suited for those with mild to moderate disease involving only small areas. 

Patients with psoriasis should know that the long-term use of a topical steroid, especially in extensive distribution, may cause several side effects on the skin.  At times, side effects may be similar to those of steroid medications taken orally. Known as local and systemic side effects, respectively, these include skin atrophy or thinning of the skin, stretch marks, acne from eruptions, skin infections, bruising, prominent skin blood vessels and hypopigmentation. In extreme cases, patient may suffer from truncal obesity, hirsutism, glaucoma and cataracts, among others.

Because psoriasis tends to repeat, it is best to avoid the sole use of topical steroids. There are many options available. There are newer medications that control psoriasis by different mechanisms and hence avoid the steroid side effects. 

One of these is the vitamin D analogue Calcipotriol, which is combined with the steroid Betamethasone diproprionate.  Together they achieve improvement in psoriatic lesions that are acceptable and safe for patients. Eventually patients are controlled even on Calcipotriol alone.

There are many things Steph learned from consulting with a dermatologist. A dermatologist gave her not only treatment regimens, but also information and insight. 

Psoriasis comes, it can be managed, and there is no need to be afraid, humiliated or cast aside. She learned that there are many others like her — and with the help of trained and Board-certified dermatologists, the best management for each of them can be found.