World Psoriasis Day: What is the skin disease and why stress may be one of the causes

Every year, World Psoriasis Day is observed on October 29 around the world to raise awareness about skin disease and to support people living with it. The theme for 2024 is 'Family' to recognise the challenges faced by the person with psoriatic disease and the family. It is unfortunately because the stigma around the condition makes people who are dealing with it suffer from social isolation or looks that may not be in support of them.

Firstly, what is psoriasis? Dr Parul Khot, consultant dermatologist, at Holy Family Hospital in Bandra explains, "Psoriasis is a multifactorial disease. The most important factor is the genetic predisposition, and 40 per cent of affected patients have a positive family history. Overproduction of skin cells and inflammation occur due to the imbalance of the immune system." Additionally, the Mumbai-based expert further explains that in the majority of patients, triggers like stress psychologically affect them. One environmental contributing factor for this disease's causation involves bacterial, viral, and fungal infections. Other drugs that contribute to this disease are beta-blockers and antimalarial drugs. The minimal sunlight and humidity have also been regarded as a cold weather condition.

As individuals with psoriasis are still seen differently by people who don't suffer from it, mid-day.com spoke to Dr. Rinky Kapoor, consultant dermatologist, cosmetic dermatologist and dermato-surgeon, The Esthetic Clinics, Mumbai, and Khot to shed light on the condition. They not only share the many causes but also highlight how it can affect the individual not only physically but also mentally. They also share how not only families but also friends and society can avoid isolating them.

What are the causes of psoriasis?

Kapoor: The exact cause of psoriasis is unknown though various factors such as cold and dry weather, certain medications, allergies and infections, alcohol, smoking, stress, and hormonal changes can aggravate this condition.

Khot: The causes may also trigger psoriasis biologically and due to lifestyle. When the patient has an autoimmune condition such as rheumatoid arthritis, lupus, or Crohn's disease, the susceptibility to developing the condition is higher. Obesity and inflammation exacerbate the symptomatology of the disease; however, smoking and excessive alcohol consumption exacerbate the severity of symptomatology.

What are the symptoms of psoriasis?

Kapoor: The warning signs of psoriasis are itchy skin, cracked and dry skin, joint pain, patches on the skin, itchy skin, and nail changes that should be reported to the expert.

Khot: Psoriasis consists of different manifestations and plagues 2-3 per cent of the world's population. Common manifestations include the following: Red, scaling inflammatory patches or plaques on the skin, typically on the elbows, knees, scalp, lower back, and buttocks. The lesions often lead to itching, stinging, or burning sensations. Tiny spots that bleed are observed as little dots when scratched (Auspitz's sign). Other signs include pitting, thickening, or separation of nails, joint pain or stiffness (psoriatic arthritis), and swelling of hands or feet.

The symptoms of psoriasis vary from person to person and may be stimulated by stress, infection or medication. Milder forms present as small, localised lesions; the more serious form is extensive skin involvement, itching and discomfort.

Initial warning signs include dryness, irritation or a burning sensation on the skin. Seeking medical help early on leads to proper diagnosis and tailored treatment that does much to improve the quality of life.

Is there a particular age at which people start getting psoriasis? Is a particular age group more vulnerable?

Kapoor: People of every age group are prone to psoriasis and no particular age group exists. However, those who have a family history, ones who smoke, drink alcohol, and are stressed can be at a greater risk of psoriasis.

Khot: Psoriasis typically manifests between 15 and 30 years, peaking during young adulthood. The age-related curves show two separate peaks; these peaks occur early in the disease (15-30 years), when most patients are between 15 and 30 years of age. Peak incidence also seems to be seen during late-onset cases, occurring between 50 and 60 years of age. Usually, early-onset cases are associated with genetic predisposition, whereas most cases of late-onset plaque psoriasis result from environmental factors.

Does psoriasis affect men more than women or vice versa?

Kapoor: Psoriasis doesn't discriminate between men and women. It affects both, equally. So, it is difficult to estimate the exact numbers.

Khot: It equally occurs in the two genders but at a different prevalence rate. It has been found by researchers that, psoriasis has similarities in prevalence patterns with both men and women, but a difference exists in how it might emerge and affect or be severe and severe differently between the sexes.

Men: The experiences are severe and commonly occur at younger ages; the common age of onset is approximately about 20 to 30 years old. There is also a greater tendency in patients towards the development of psoriatic arthritis. Scalp, face, and genital areas are the common sites to develop lesions.

Women: Generally, women have a later onset (peak age 30-50 years), milder symptoms, and greater associations with hormonal fluctuations. Women are more susceptible to inverse psoriasis (flat, red lesions in the folds of the skin) and psychological symptoms.

Causes of gender differences

1. Hormonal effects: Menstruation, pregnancy, and menopause frequently cause symptoms.
2. Genetics: Equal susceptibility, but it might take different forms.
3. Lifestyle factors: Smoking, weight gain, and stress occur more commonly in men.
4. Immune system variations: The gender difference in immune response influences the manifestation of diseases.

Is it possible to treat psoriasis? If yes, what are the treatment options?

Kapoor: The doctor will prescribe ointments, creams, and phototherapy are treatment options for psoriasis. One will also be recommended counselling to overcome depression and anxiety caused by this condition.

Khot: Treatment for psoriasis focuses on multi-dimensional treatment by fighting physical, emotional, and lifestyle factors. Although a complete cure is not yet available, such treatments manage to control symptoms and improve quality of life with minimisation of complications in the process. Topical treatments include creams, ointments, and lotions that prevent inflammation and slow down the growth of skin cells. Another option used as treatment is known as light therapy, often ultraviolet B phototherapy and narrowband UVB, used to curb the condition and its symptoms effectively.

Systemics include oral or injective drugs like methotrexate, cyclosporine, and biologics that have a likely anti-inflammatory and immunosuppressive action. Such agents must be used along with lifestyle measures including stress management, exercises, healthy diet, and smoking cessation. Combination therapy includes the use of more than one form of therapy that can provide the best individual results based on the severity of the disease, medical history, lifestyle, and patient choice. A treatment plan designed according to the needs of the patient, careful follow-up, and proper education give a great impact on the management of the condition.

What are the challenges that a person with psoriasis can suffer from and how do they deal with it?

Kapoor: People with psoriasis will be unable to do his/her daily activities with ease due to symptoms such as itchy skin, cracked and dry skin, joint pain, and patches on the skin, he/she will be embarrassed, guilty, and may feel ashamed. He/she will avoid socialising and may also be ridiculed for their appearance. This condition can cause stress, anxiety, and depression.

Khot: Psoriasis patients suffer several problems. Physically the painful rash and its itch and scalp manifestation may limit mobility and sleep. Psychologically, low self-esteem, anxiety, depression, and social withdrawal are huge problems. Socially, feelings of shame, embarrassment, relationship strain, and workplace discrimination add to difficulties. Comorbid conditions such as psoriatic arthritis, cardiovascular disease, and metabolic syndrome add to these problems.

Strategies to cope with situations. Support networks - family, friends and groups - offer emotional consolation. Lifestyle changes such as well-balanced diets, exercise, stress management and smoking cessation reduce symptoms. Mindfulness, meditation and therapy stabilize one's emotions. Education enables one to care for oneself and to make intelligent decisions. Self-advocacy ensures that one's needs, boundaries, and accommodations are communicated.

There is a need for expert support provided by dermatologists, therapists, and counsellors. Strengths-based stress responses and coping skills include setting goals and affirmations. Early intervention, holistic care, and individualised support significantly enhance quality of life.

What are the effects of psoriasis on physical and mental health?

Kapoor: People will have joint pain, psoriasis can increase the risk of chronic obstructive pulmonary disease (COPD), and lack of sleep. This condition can take a toll on one's eyes causing redness and pain. Trauma, depression, anxiety, loneliness, agitation, irritation, suicidal thoughts, and low self-esteem are commonly seen in people.

Khot: Psoriasis is a disease where individuals have to face many challenges. The physical factors include painful skin lesions, itchiness, scaling and cracking, which bring about impairments in mobility and sleep. On the psychological side, there is low self-esteem, anxiety, depression, and isolation. Worsening on a social basis includes stigma, embarrassment, strain in relationships, and workplace discrimination. Other comorbidities include psoriatic arthritis, cardiovascular diseases, and metabolic syndrome among others.

Lifestyle modifications with balanced diet and exercise, stress management, smoking cessation, and emotional support gained from family, friends, and groups through support networks stand out as various coping ways.

Changes in lifestyle, emotional comfort, mindfulness, meditation, and therapy help to level the emotions. Education is empowering for self-care and decision-making, and self-advocacy will see that all the needs, boundaries, and accommodations are communicated to those around them.

Professional support by dermatologists, therapists and counselors is necessary. Resilience-based skills are strength-based and goal-oriented with use of affirmations. Early intervention with comprehensive care and personal support help dramatically improve the quality of life.

How can people around those with psoriasis help them?

Kapoor: It is the need of the hour to educate people about psoriasis and its side effects. There should be campaigns, initiatives, and drives conducted to spread awareness regarding psoriasis and dispel myths and taboos related to this skin condition.

Khot: Supportive networks do enhance the care of patients with psoriasis. Family, friends, and caregivers are of great importance in educating themselves about the condition, encouraging one to comply with the prescribed treatment and lifestyle changes, and providing emotional and psychological support and empathy. Friends can assist in helping with performing daily tasks, managing stress, self-care, exercise, and diets. Accompanying a patient to attend appointments enhances communication, eliminating stigma, since it creates awareness about this aspect. This support environment enables patients with the disease to take proper care and enhances their disease management, which improves their quality of life.

How can people in general be sensitised about psoriasis to make those with it comfortable?

Khot: Psoriasis sensitises others towards creating comfort and acceptability. Awareness for others towards the physical, emotional, and societal impacts of the disease. Psoriasis is not a contagious disease. It breaks stigmas with education. It encourages empathy, understanding, and openness. Create welcoming workplaces, schools, and social circles. Use respectful language where derogatory terms are used. Encourage inclusion and accessibility. Accommodation needs to be made. Carry out awareness events through rallies, social media, and support groups. Equip healthcare professionals to give direction. Empathy and know-how have enabled the public to convey a sense of reassurance while avoiding feelings of isolation and embarrassment.

Can people eat a certain kind of food to deal with psoriasis? If not, how can they manage their life around it?

Kapoor: It is essential to accept the person the way he/she is. It is also important to not to judge someone by his/her appearance and make one comfortable as much as possible.

Khot: Psoriasis can be managed through changes in dietary habits. Even if there is no such thing as a "psoriasis diet," the following foods are beneficial: Fatty fish and their products, rich in omega-3 fatty acids (salmon and sardines); Fruits and vegetables with high levels of antioxidants: berries, leafy greens; Whole grains; Yogurt with probiotics, turmeric and ginger for anti-inflammatory purposes

These are to be avoided: Gluten for sensitive people Dairy for those with lactose intolerance, processed foods, Sugary beverages, and saturated and trans fats.

Disclaimer: This information does not replace professional medical advice. Consult a qualified expert for personalised guidance.

Also Read: Mumbai: 31-year-old man overcomes Psoriasis, achieves dream of getting married after effective treatment