13 May 2011
Psoriasis affects 1 in 50 adults and can be controlled well but Doctor-hopping, looking for an elusive cure, is often counterproductive
THERE ARE few skin conditions that are mostly harmless, but cause enormous psychological trauma because of the associated cosmetic disfigurement and social stigma. Psoriasis is one such condition. However psoriasis is not uncommon and the severity varies considerably. Have you ever been told that you have psoriasis by a doctor and been worried about it ever since? If you do a bit of research, you may be alarmed by the terrible images online. But do you really need to be worried?
Psoriasis affects 1 in 50 adults. Most of the so-called severe and resistant dandruff could actually be psoriasis of the scalp. Psoriasis of the scalp leads to intense, thick scaling over certain areas, predominantly over the front hair margins, with minimal itching. The ‘psoriatic dandruff’ may not respond well to ordinary anti-dandruff shampoos.
Majority of psoriasis remains confined to certain areas of the body, with minimal discomfort except for its awkward appearance. A person with psoriasis generally has patches of raised red skin with thick silvery scales. The usual sites are elbows, knees, scalp, palms and soles. Blood tests and biopsies are rarely needed to diagnose psoriasis, though investigations may be needed for monitoring treatment. They often improve with creams (even moisturising creams) but may not subside completely or can come back spontaneously even with medicated creams from a doctor. Hence psoriasis is often a cosmetic concern, which like most other cosmetic concerns is virtually impossible to abate.
In few unlucky ones, psoriasis can be severe and in rare cases, even life threatening. It can involve extensive areas of the body including the nails. It can cause joint pains in few, mostly in the joints of the fingers and toes. There is a variant of psoriasis that occurs predominantly in children and young adults. This type fortunately subsides completely in a few weeks, even without treatment. Psoriasis can be pus-filled occasionally. If it is extensive or pus-filled, you should consult a doctor. It may occasionally become severe during pregnancy.
Psoriasis is not an infection and hence definitely not contagious even with close contact. But it may run in families as certain genes are implicated in its causation. There are certain factors that can aggravate psoriasis. Stress is commonly implicated and many psoriatics improve during vacation. Smoking and alcohol intake can also adversely affect it. Even ‘over the counter’ fever and headache medications can worsen the condition. It can occur over regions of constant pressure or injury.
Occult infections like a sore tooth or urinary tract infection can also worsen psoriasis. Yet another cause for dangerous aggravation of psoriasis is aggressive and inappropriate treatment. Changes in diet and lifestyle can have a beneficial effect on psoriasis. Fish oils containing omega-3 fatty acids are known to improve psoriasis. Dead Sea area is also known to improve psoriasis by a combination effect of Dead Sea salts and sun exposure.
It is important to realise that psoriasis is an incurable (at least at present) genetic tendency to form skin cells at a faster rate. Aim of treatment is to control the symptoms enough to ensure good quality of life. Though newer modalities of treatment are available, almost all of them have side effects and are used for the management of severe psoriasis only. Having said that, I will help you choose the correct treatment for your psoriasis.
The first step is to confirm the diagnosis. A dermatologist would be able to confirm the diagnosis in most cases even without expensive tests. Do a bit of introspection to find out how much you are actually concerned or how much it is affecting your day-to-day life. If psoriasis is not too much of a concern for you, just use a moisturiser and avoid all the aggravating factors I mentioned above. Inexpensive mineral oils like liquid paraffin and vegetable oils are as effective as expensive fragrant moisturising creams.
If the above measures fail and if your condition is not severe, your doctor will most likely start you on certain creams or ointments and medicated shampoo, if your scalp is involved. Many of these medications are not for long-term use. Follow your doctor’s instructions regarding the duration of use. As mentioned earlier, complete cure is often not possible and the aim of treatment is good control. Doctor-hopping, looking for an elusive cure, is often counterproductive.
If you have extensive psoriasis, your doctor may consider more aggressive treatments. Occasionally, psoriasis occurring on certain locations like palms and the face may affect day-to-day life even if the condition is not extensive and may require aggressive treatment. It is important to have a frank discussion with your doctor regarding this.
Aggressive treatment options for psoriasis range from phototherapy (a form of light treatment) to the latest monoclonal antibodies or biologics. Most of these treatment modalities require expertise and regular follow-up, as side effects are a major concern. These facilities may not be available in all health care facilities.
Psoriasis shows great variation in its presentation ranging from mild cosmetic concern to life threatening conditions. There are several treatments available for good control though complete cure is not possible.
(Dr Bell R Eapen is a Dubai-based specialist dermatologist with Kaya Skin Clinic. This is a fortnightly
column. Write to him at