‘I’m embarrassed of my skin’

MANILA, Philippines -  â€œNahihiya ako dahil sa balat ko.” Too often, this is the painful cry of persons afflicted by psoriasis. This socio-behavioral reaction to a “visible condition” dates back to ancient times when physical appearance is a big determinant of the “honor and shame” that one may bring to one’s self, family, and community. 

Even in today’s world where a big percentage of social interactions are over the Internet, even the powerful photo-enhancing software may not completely alleviate their “embarrassment” in posting and sharing their photos.

The skin is the biggest organ of the body, the most visible and observed by all. Visually, psoriasis is perceived as reddish skin lesions with silvery, white flakes commonly seen on the hands, arms, elbows, legs, knees and scalp.

Even those still in the early stages of affliction take conscious efforts to check their shoulders for snow-like flakes and the seats where they got up. In their mind, these precautions lessen the chances of people they encounter to discover that they have psoriasis. 

But since it is a chronic disease, these routines in their own chapter of the social etiquette book, become part of their lives. And it can be tiring at times.

By touch, one would feel very dry, rough and the skin thickened. Most patients would shy away from being touched by others or engage in activities that would entail skin contact.

And because of the inherent pathology of the disease, too, the sweat glands that are integral to the skin, also become abnormal, causing patients to emit a peculiar smell. This is aggravated by their inability to control body temperature. 

Imagine how a psoriasis patient feels when he knows that three out of the five senses of those around him are activated in each social encounter. 

Having to wear long-sleeved shirts to keep warm and hide the skin lesions, can well make them perspire more that would aggravate the skin condition and increase bacterial infections that emit malodorous scent.

Because of such “socially challenging” nature of the disease, self-medication among psoriasis patients is common. Many have turned to steroids that, in most cases, are suggested by those who have come forward to give some “honest advice” or just about anyone they have confided in.

Results can be encouraging as rightfully, steroid therapy is part of the medically accepted management of the disease.  But abuse has become common because the temporary relief from some of the symptoms becomes an “addiction.”

Steroids cannot and should not be used as prolonged therapy because of their numerous side effects. Excessively thinned-out skin causing permanent damage like stretch marks; the danger of too much absorption into the body, causing hormonal dysfunction that in excess may be life-threatening (Cushing’s syndrome); acne eruption; and increased risk of infections to different agents because of decreased body immunity are just some of the common side effects.  

Chronic disease

Psoriasis is a chronic skin disease.  According to Dr. Irene Gardiner, medical director of LEO Pharma, the root cause is within one’s body. It is also considered autoimmune, as its own immune cells are causing the skin cells to increase the cellular turnover, leading to the visible shedding. 

The normal skin gets renewed every 28 to 30 days. It does not happen all at the same time and is inconspicuous to the naked eye. For a psoriasis patient, this skin renewal cycle happens within two to three days in the affected areas. This rate is too fast for the skin to shed, hence the skin build-up that brings about the flaking and thickening of the surface.

Because there is still no treatment to psoriasis, pharmaceutical companies have thus far only offered products to medically manage and alleviate its symptoms. Steroids remain the gold standard in therapeutic management, although they are also known to bring many side effects. 

Topical agents

This is the primary reason why combined topical agents are formulated to minimize side effects and increase therapeutic effectiveness. A topical drug that has shown long-term safety in psoriasis is the combination of vitamin D and betamethasone. This therapy is supported by a clinical study done over a 52-week period. 

A word of caution though — a regular checkup and supervision by a dermatologist during therapy is imperative as psoriasis is not only a “skin-deep problem,” pun unintended.

A comprehensive medical approach is necessary in the management of this challenging disease. Topical drugs may be combined with oral medications. Psychological guidance is also important to bring back the obviously lost self-esteem of one that cries, “I’m embarrassed of my skin.”