Psoriasis continues to be a public health problem not only because there is no known cure, but also because there is a severe lack of recognition and awareness, a lack of correct diagnosis, and a lack of understanding about the nature of the disease by the patient, the health provider and the public at large.
Psoriasis affects 125 million or nearly three percent of the world’s population. In the Philippines, it is estimated that about 1.8 million Filipinos are suffering silently with Psoriasis. The disease can develop in males and females of any race or age, across all socioeconomic groups. It often appears between the ages of 15 and 25, although it can strike at any age including infants and the elderly.
Psoriasis is a serious inflammatory, non-communicable autoimmune disease which carries severe physical, mental and socioeconomic burdens to people afflicted with the disease.
The Burden of Psoriasis
According to the US National Institute of Arthritis and Musculoskeletal and Skin Diseases, a division of the National Institutes of Health, psoriasis is driven by the immune system, especially involving a type of white blood cell called a T cell.
Normally, T cells help protect the body against infection and disease. In the case of psoriasis, T cells are put into action by mistake and become so active that they trigger other immune responses, which lead to inflammation and to rapid turnover of skin cells.
Plaque psoriasis is the most common type where patches of skin called “lesions” or “plaques” become red and inflamed, and are covered by a white scale. Psoriasis can be limited to a few lesions or can involve moderate to large areas of the skin and scalp. The severity of psoriasis can vary form person to person, however, for most people, psoriasis tends to be mild.
The other forms of psoriasis include: Guttate psoriasis, which is characterized by red, small, dot-like lesions covered with silvery white scale; Pustular psoriasis which has blister-like lesions of fluid, which is not infectious, and intense scaling. It can appear anywhere on the body, but often it appears on the palms of the hands and the soles of the feet; Inverse psoriasis which has very red lesions with little or no scales and appears in the skin folds, such as the arm pits, creases in the groin and under the breasts; and Erythrodermic which is a particularly inflammatory form of psoriasis that often affects most of the body surface, and characterized by periodic, widespread, fiery redness of the skin, and erythema (reddening) and exfoliation (shedding) of the skin are often accompanied by severe itching and pain.
Patients having an erythrodermic psoriasis flare must seek medical attention and be hospitalized immediately because protein and fluid loss can lead to severe illness. Infection, pneumonia and congestive heart failure brought on by erythrodermic psoriasis can be life threatening.
Physically, psoriasis is uncomfortable, itchy and painful, with inflammed, cracked and bleeding lesions.
Recent studies have shown that people with psoriasis are at an increased risk of other inflammatory diseases such as arthritis, cardiovascular disease, diabetes, Crohn’s disease, hypertension, irritable bowel syndrome, lupus, and obesity, and can result in early death.
Psychologically, patients are embarrassed, humiliated, and tend to hide their skin from the critical public. The feelings of self-consciousness, frustration and shame may often lead to depression and alcoholism, and may cause severe mental trauma and thoughts of suicide.
Socio-economically, psoriasis limits employment opportunities and imposes a serious barrier in the job market. In a survey done by the Swedish Psoriasis Association, one in four people believe that it is harder to get work if you have psoriasis, and the same say they cannot choose the work they want, feeling discriminated against.
High rates of absence through psoriasis-related illness are also reported, and people with psoriatic arthritis often work part-time because of it. In the US alone, the economic impact is estimated that Americans with psoriasis lose approximately 56 million hours of work and spend $2 to $3 billion to treat the disease every year.
Developing countries with less resources and health care have an even greater economic burden due to misdiagnosis of the disease, stigmatization and discrimination, and little-to-no access to affective treatments. People with psoriasis are often ostracized and barred from positions in the job market where people can “see” them linking psoriasis with low income and poor quality of life. The humanitarian, social and economic costs are immense.
Mounting data show that it is critical that psoriasis, especially the inflammatory state, be managed and diagnosed early. Psoriasis has no known cure, but many different therapies can reduce, or nearly stop, their symptoms, although no single treatment works for everyone. Many psoriasis patients report using various treatments at the same time.
The treatment ranged from the use of topicals and moisturizers which is the most common, to sunlight and phototherapy or use of ultraviolet light, UVA or UVB for patients with moderate to severe psoriasis, and to systemic treatments such as Methotrexate and Clysosporine given in the form of a pill or injection for severe psoriasis.
Systemic treatments can have serious potential risks on other parts of the body including the liver and kidneys, and patients commonly report nausea, hairloss and flu-like symptoms. However, many patients worldwide on systemic drugs may have had a good life for many years.
Biologics are the newest class of treatments for moderate-to-severe psoriasis and are also used to treat psoriatic arthritis. Biologics, such as Enbel and Humira, are given by injection and Remicade is administered intravenously. These drugs, which are extremely expensive, inhibit the immune system from over-reacting and over-producing certain cells.
Why Psoriasis Continues
The IFPA, in its efforts to push psoriasis as a global and national public health concern, has laid out the following reasons why psoriasis continues.
• Psoriasis continues because there is no known cure.
• Psoriasis continues because of the lack of education, in both health care providers and psoriasis patients, on the nature of the disease. Psoriasis is still mistaken for numerous other diseases, including leprosy or as a cosmetic problem.
• Psoriasis contiues because of the lack of interest and of funding for genetic and clinical research into the cause of and the cure for psoriasis and other inflammatory noncommunicable diseases.
• Psoriasis continues because stigmatization, embarrassment and discrimination force psoriasis patients to hide their skin and isolate themselves from the general public, often resulting in severe psychological and poor socio-economic conditions.
• Psoriasis continues because, when diagnosed properly, it is under-treated and dismissed as a psoriasis health concern. New medications that significantly reduce psoriasis and other inflammatory diseases are often not available, are very expensive, and not covered by all health care plans. Often when coverage is provided, there are stipulations that a psoriasis patient must try and fail certain medications first, like topicals and systemics, and sometimes this can take over a year or more.
• Psoriasis continues because there are barriers to policies that could greatly change the impact of the disease. Politically, there is a general lack of attention to psoriasis because psoriasis, if it is recognized and properly diagnosed, is considered “cosmetic” or skin diseases, not a disease of the immune system that has serious implications and causes severe physical, mental and socio-economic disabilities. If psoriasis is continuously looked at as a cosmetic disease or is not even identified as a disease, how can policies be written in support of psoriasis patients?
Professor Joerg C. Prince, professor of Dermatology at the University of Munich, states that “due to the early onset of the disease psoriasis patients are exposed to lifelong suffering. He said that psoriasis is a disease, which according to the WHO definition of health, is associated with major social, physical and mental restrictions and thus fulfils the criteria for the absence of health much more than many other severe medical disorders. According to the definition of disease burden, psoriasis patients are facing many years of healthy life lost by virtue of being in states of poor health and disability and they lose a number of years of life due to premature death resulting from psoriasis and its co-morbidities.
Isn’t it about time to change our views and declare psoriasis as a serious disease deserving global and local attention?
--- ABOUT THE PHOTO: Actor Robin Padilla hugging PsorPhil Moderator Liza dela Cruz during the Hug Me Campaign. Photo from PSORLiFE - the official publication of Psoriasis Philippines.