Lifelong itch
My first experience with the condition was in my third year in high school. It started as subtle red bumps along my hairline, which gradually turned scaly. Soon after, I was experiencing dandruff, and additional lesions appeared on my back and my legs. I was in an eternal state of itchiness and scratching was the only thing that brought relief. At times, after a vigorous rub, my skin and my scalp would feel so raw and painful. Feelings of regret would eventually follow, knowing that there was the real possibility of having an infection to complicate matters. Our kind-hearted, brilliant dermatologist took one look and promptly prescribed a tar-based solution. Thankfully it was effective but it smelled awful.
She was a batchmate in medical school. Her condition was similar to mine but worse. She had the same lesions, but they were more extensive. Her back had a cobblestone-like appearance and she would experience occasional joint pains. I would sometimes find her using the door frame as a back scratcher. She would always make light of her condition by saying that scratching had become a hobby. From her, I learned to make peace with what I had.
The diagnosis? Psoriasis. It is defined as a chronic multisystemic inflammatory disease that largely affects the skin and bones but can involve other organs as well. The pathophysiology is complex and stems from a dysregulated immune system. From literature, the identified co-morbidities have included but are not limited to: hyperlipidemia, diabetes, cardiovascular disease, metabolic syndrome, liver fibrosis, nephropathy, and depression. It can affect anyone, regardless of age, gender and race, but is still predominantly considered as an adult disease. A strong genetic predisposition has been supported by findings of a family history in those who have been afflicted.
Currently, the cause remains elusive, but certain trigger factors have been linked to inciting or exacerbating psoriasis such as irritants or allergens, cardiovascular medications, changes in weather conditions, smoking, alcohol use, and emotional stress. A systematic review and meta-analysis found insufficient data for its association with the latter. However, the studies included were primarily retrospective and had limitations. Analyzing my situation, the only thing that worried me then was how to handle a hyperactive classroom full of opinionated young women and the probability of being summoned to the principal’s office as the president of the section. However, having had several minor flare-ups as I got older, I was able to identify highly stressful situations as my personal trigger that would bring an unwanted lesion and the unbearable itch.
Manifestations may range from being mild to severe. There are four variants of which the most common is the chronic plaque psoriasis. These lesions are typically seen on the scalp, face, buttocks, trunk, extremities, and may involve the nails. It can be mistaken initially as atopic dermatitis, contact dermatitis, pityriasis rosea, or tinea corporis. If classified as mild, patients usually respond to topicals and steroids. Moderate and severe disease may necessitate the use of phototherapy and the use of non-biologic or biologic agents. These treatments need to be closely supervised by specialists as there may be adverse outcomes aside from being prohibitive in cost.
Due to the chronic nature of the condition, the absence of a cure, the probability of recurrence, and the cost, management, and compliance with treatment are constant challenges. Moreover, it is the emotional impact of having the disease that is hardest to deal with. Since it is primarily manifested on the skin, anyone with scant knowledge of the condition might think it is highly infectious in nature upon seeing the plaque-like lesions, resulting in placing both parties on the defensive. I was diagnosed as an adolescent and you could just imagine how it affected my self-confidence. Fortunately, I was responsive to treatment, but what about the others? Reading and hearing testimonials, patients have spoken about how it has affected the quality of their lives, their social interactions, their self-esteem, and self-worth. Who can blame them for struggling with a condition that can be short of devastating?
Psoriasis remains to be an underdiagnosed condition despite increased awareness. Successful management involves the institution of early treatment intervention. Though it is not generally fatal, its psychosocial impact can be severely limiting to the point of incapacity.
Having given you a briefer, it is my hope that the next time you obsess or worry about a minor condition such as a pimple, a blemish, or a scratch, remind yourself to be grateful that you don’t suffer from psoriasis. There are so many other things that deserve our attention beyond the superficial. For those who have the opportunity to know someone suffering from the disease, you can make their day by giving them that much-needed emotional support.
