No need to fear it
DR. MURLIDHAR R
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Psoriasis can be treated with early diagnosis and lifestyle changes.
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PSORIASIS is one of the most common skin diseases in India ... It affects almost 4-5 per cent of the population, hence the misgiving and dread associated with the condition. Psoriasis is probably one of the longest known illnesses of humans. Some believe psoriasis to have been included among the skin conditions called tzaraat in the Bible. It was also initially confused with leprosy, until 1841 when a Viennese dermatologist von Hebra identified it and defined it as psoriasis, derived from the Greek word psora meaning `to itch'.
How it happens
The outer layer of the skin, the epidermis, has many layers of cells, which divide to maintain the integrity of the skin. The epidermis is, therefore, supplied by blood vessels and immune cells. In psoriasis, these immune cells, called t-cells, interact with the epidermis and then with the general immune system of the body to produce cells, which home in into the epidermis. Once they get here, they produce at an increased rate of cell division.
This leads to a thickened patch of skin, the outer layers of which fall off as scales. Since there is so much cell division, there is also an increase in the blood supply and the patches are inflamed and can sometimes be very itchy. These patches can occur anywhere. The severity of psoriasis is often graded according to the extent of occurrence and symptoms.
Sometimes the disease is so severe that it occurs all over the body, called erythroderma. This can result in serious metabolic problems, protein loss and even death. Another potentially fatal form of psoriasis is called pustular psoriasis — where the immune cells rapidly enter the skin in pus-filled spots all over the body. This can happen over a matter of hours and, if not treated early, can lead to death. One common cause of this is administration of systemic steroids to a psoriatic patient.
Treatment options
Most forms of psoriasis are however mild and easily treatable. They are usually localised to a few areas of the body and sustained targeted treatment with drugs specific to those areas can lead to lasting remissions.
Some forms of psoriasis affect the quality of life — say, a patient who has the disease on the palms or a model with patches on the face — such patients will need aggressive therapy.
There are several external agents, which can help a patient with psoriasis. For mild disease, external creams containing steroids used judiciously help. However they need to be withdrawn gradually. Better creams contain tazarotene, a topical retinoid or calcipotriol, which stops cell division. On the face, creams containing tacrolimus or pimecrolimus are used.
Several systemic drugs are useful in cases, which warrant therapy. Systemic retinoid therapy uses a promising drug called acitretin now, but this should be used carefully in women of childbearing age. Methotrexate, an age-old drug, is better in short periods of time of, say, three to four months. But liver functions need to be monitored carefully. Cyclosporine can also be used for short periods of time. These drugs can therefore be used sequentially in patients so that the patient is not exposed to any single drug for too long. This yields very good results in terms of inducing long-lasting remissions and at the same time protects the patient from side effects.
Latest advance
The latest advance in psoriasis therapy today is biologicals. These drugs target the root cause of psoriasis, the immune cells. Several are available — etanercept, infliximab and efaluzimab to name only a few that have been introduced. They hold the promise of long-term remissions and a real approach to targeting the cause of the disease rather than symptomatic therapy. They require considerable expertise on part of the treating physician. At present they are the most promising drugs to treat this condition.
What about lifestyle? Psoriasis is intimately linked to lifestyle. Alcohol, obesity and lack of exercise all carry a worse prognosis. So the future for psoriatic patients is quite good. There are good drugs and a better understanding of the disease. This is not infectious and will not pass on to your children. Early treatment and lifestyle modification help.
The need of the hour is to form a national support group for psoriasis patients and motivate patients to be positive and take proper treatment.
The writer is a senior consultant and Head, Department of Dermatology,
Apollo Hospitals, Chennai.
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