Psoriasis cases are on the rise, say dermatologists. What are the causes and how do you treat the condition?
Experts say that while psoriasis primarily manifests on the skin, it is defined as a systemic inflammatory condition affecting multiple systems in the body.
Understanding why psoriasis occurs
According to the National Psoriasis Foundation, a non-profit organisation based in the United States, psoriasis plaques occur because of an overactive immune system, resulting in faster skin cell growth. While normal skin cells grow completely and fall off in a month, in persons with psoriasis, skin cells pile up on the surface of the skin. Symptoms include flaky skin and raised, discoloured bulges on the skin, akin to boils. Some have blisters, itching and even bleeding. Some exhibit ridges along the nailbed. Some also have pustules, which break and leave scabs. It can occur in the palms, soles, scalp or elbows and in skin folds. Psoriasis is not a contagious condition, but results in low confidence in patient.
Krishnan* was diagnosed with psoriasis in 1991, when he was 20. 'My father took me to a doctor who diagnosed my condition. It started as a scar on my bottom, spreading to my back and the armpits. It is persistent still, and flares up during winters,' he says. Mr. Krishnan was an active cricketer until the condition began to demotivate him. It also resulted ibn him avoiding a steady job. 'I bathe twice a day. I have tried everything, from powder to lotion to ointments and even injectables,' he reveals, but psoriasis persists.
The condition can also run in families. His brother was diagnosed with the condition as well, Mr. Krishnan says. 'But he leads an active life and does not have as many scars or episodes. He is a medical professional, and his condition is milder.'
More research needed
In an article 'Psoriasis in India: Prevalence and Pattern' publishedin the Indian Journal of Dermatology, Venereology and Leprology in 2010, the authors Dogra S. and Yadav S. of the Department of Dermatology, Venereology and Leprology at the Postgraduate Institute of Medical Education and Research, Chandigarh, said the prevalence in India and the epidemiological characteristics are similar to that of the disease in the West. They maintained that in India, the prevalence varied from 0.44% to 2.8%.
The authors called for more research and a detailed prospective study to delineate the natural course of the disease, as it varied in different individuals. They also called for further research to identify risk factors to prevent the condition and pointed to lack of reliable information on time trends of the disease.
Current trends and treatment approaches
Much water has flowed under the bridge in the past 15 years, says U.R. Dhanalakshmi, a Chennai-based dermatologist. She has seen an increase in the number of cases of psoriasis in recent years. She points out that with an increase in the number of people with diabetes, psoriasis has also risen. While the mild conditions are treated using creams and over the skin applications, severe cases may need longer and more intense treatment. Co-morbid conditions such as hypertension, thyroid dysfunction and diabetes aggravate the condition making it difficult to control, she explains.
Unlike in the past, when the only treatment options were powders, creams and lotions, currently there are advanced methods to treat psoriasis. Patients with severe psoriasis are prescribed biological drugs. 'The condition manifests in genetically prone individuals. It is not that the biological drugs will eliminate the infection. But they target overactive parts of immune system in order to reduce inflammation,' she explains.
Stressors such as work and family pressure are triggers. 'It is a recurring disease as the person is exposed to the same work life and stresses. It can occur among people without any genetic load either, she says. Lifestyle modifications that help avoid triggers could play a role in managing symptoms, she adds.
A 51-year-old farmer from a suburb of Chennai discovered he had the condition in 2021. He was diagnosed after a bout of COVID 19. The condition, he says, flares up during monsoons and winters. Unlike Mr. Krishnan, this patient has managed to keep it under control, with maintenance drugs whenever there is a flare up.
Why are cases on the rise?
'Over the past seven years that I have worked in academic institutions and private practice, the number psoriasis of cases has gone up from 2 or 3 cases in a day to as many as 6 or 7 per day,' says Monisha Madhumita, an assistant professor in the Department of Dermatology, Saveetha Medical College in Chennai. 'Increasingly a younger demographic is being affected,' she adds. In all her patients the metabolic syndrome has been impacted, she adds, indicating that it is a systemic condition similar to diabetes and hypertension.
Psoriasis may manifest as a skin condition, but, Dr. Monisha says, could cause heart attacks, fatty liver, and affect mental health as well.
Mental health is an aspect of the condition that may often go under-recognised: Mr. Krishnan, who continues to struggle with psoriasis is now resigned to his condition. He has tried every medication that is available, including Indian systems of medicine. He has also now been diagnosed with fatty liver. Lifestyle changes however are challenging for him.
'We have seen that obesity, exposure to microplastics, endocrine disrupting chemicals and personal care product use are also reasons for the rise in psoriasis cases,' Dr. Monisha surmises. 'I see younger populations with more severe forms of psoriasis,' she adds.
The most common varieties she treats in her clinic are chronic plaque in elbows, knees or other parts of the body, and persistent infection in the scalp. There are also those with childhood psoriasis that can resolve as they grow older. Among the severe forms are psoriatic arthritis, and erythrodermic psoriasis where 90% of the body becomes red and the person sheds skin in large sheets, requiring to be hospitalised.
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Psoriasis (so-ri'a-sis, a word of Greek origin) is a chronic skin disorder in which red, scaly plaques appear on the skin. The knees, shin, elbows, naval, buttocks, lower back, ears and hairline, are most commonly affected. Some people suffer from pitting of nails as well. Dermatologists say patients have varying degrees of the condition -- from mild discomforting changes, to severe, debilitating forms. Experts say that while psoriasis primarily manifests on the skin, it is defined as a systemic inflammatory condition affecting multiple systems in the body. Understanding why psoriasis occurs According to the National Psoriasis Foundation, a non-profit organisation based in the United States, psoriasis plaques occur because of an overactive immune system, resulting in faster skin cell growth. While normal skin cells grow completely and fall off in a month, in persons with psoriasis, skin cells pile up on the surface of the skin. Symptoms include flaky skin and raised, discoloured bulges on the skin, akin to boils. Some have blisters, itching and even bleeding. Some exhibit ridges along the nailbed. Some also have pustules, which break and leave scabs. It can occur in the palms, soles, scalp or elbows and in skin folds. Psoriasis is not a contagious condition, but results in low confidence in patient. Krishnan* was diagnosed with psoriasis in 1991, when he was 20. 'My father took me to a doctor who diagnosed my condition. It started as a scar on my bottom, spreading to my back and the armpits. It is persistent still, and flares up during winters,' he says. Mr. Krishnan was an active cricketer until the condition began to demotivate him. It also resulted ibn him avoiding a steady job. 'I bathe twice a day. I have tried everything, from powder to lotion to ointments and even injectables,' he reveals, but psoriasis persists. The condition can also run in families. His brother was diagnosed with the condition as well, Mr. Krishnan says. 'But he leads an active life and does not have as many scars or episodes. He is a medical professional, and his condition is milder.' More research needed In an article 'Psoriasis in India: Prevalence and Pattern' publishedin the Indian Journal of Dermatology, Venereology and Leprology in 2010, the authors Dogra S. and Yadav S. of the Department of Dermatology, Venereology and Leprology at the Postgraduate Institute of Medical Education and Research, Chandigarh, said the prevalence in India and the epidemiological characteristics are similar to that of the disease in the West. They maintained that in India, the prevalence varied from 0.44% to 2.8%. The authors called for more research and a detailed prospective study to delineate the natural course of the disease, as it varied in different individuals. They also called for further research to identify risk factors to prevent the condition and pointed to lack of reliable information on time trends of the disease. Current trends and treatment approaches Much water has flowed under the bridge in the past 15 years, says U.R. Dhanalakshmi, a Chennai-based dermatologist. She has seen an increase in the number of cases of psoriasis in recent years. She points out that with an increase in the number of people with diabetes, psoriasis has also risen. While the mild conditions are treated using creams and over the skin applications, severe cases may need longer and more intense treatment. Co-morbid conditions such as hypertension, thyroid dysfunction and diabetes aggravate the condition making it difficult to control, she explains. Unlike in the past, when the only treatment options were powders, creams and lotions, currently there are advanced methods to treat psoriasis. Patients with severe psoriasis are prescribed biological drugs. 'The condition manifests in genetically prone individuals. It is not that the biological drugs will eliminate the infection. But they target overactive parts of immune system in order to reduce inflammation,' she explains. Stressors such as work and family pressure are triggers. 'It is a recurring disease as the person is exposed to the same work life and stresses. It can occur among people without any genetic load either, she says. Lifestyle modifications that help avoid triggers could play a role in managing symptoms, she adds. A 51-year-old farmer from a suburb of Chennai discovered he had the condition in 2021. He was diagnosed after a bout of COVID 19. The condition, he says, flares up during monsoons and winters. Unlike Mr. Krishnan, this patient has managed to keep it under control, with maintenance drugs whenever there is a flare up. Why are cases on the rise? 'Over the past seven years that I have worked in academic institutions and private practice, the number psoriasis of cases has gone up from 2 or 3 cases in a day to as many as 6 or 7 per day,' says Monisha Madhumita, an assistant professor in the Department of Dermatology, Saveetha Medical College in Chennai. 'Increasingly a younger demographic is being affected,' she adds. In all her patients the metabolic syndrome has been impacted, she adds, indicating that it is a systemic condition similar to diabetes and hypertension. Psoriasis may manifest as a skin condition, but, Dr. Monisha says, could cause heart attacks, fatty liver, and affect mental health as well. Mental health is an aspect of the condition that may often go under-recognised: Mr. Krishnan, who continues to struggle with psoriasis is now resigned to his condition. He has tried every medication that is available, including Indian systems of medicine. He has also now been diagnosed with fatty liver. Lifestyle changes however are challenging for him. 'We have seen that obesity, exposure to microplastics, endocrine disrupting chemicals and personal care product use are also reasons for the rise in psoriasis cases,' Dr. Monisha surmises. 'I see younger populations with more severe forms of psoriasis,' she adds. The most common varieties she treats in her clinic are chronic plaque in elbows, knees or other parts of the body, and persistent infection in the scalp. There are also those with childhood psoriasis that can resolve as they grow older. Among the severe forms are psoriatic arthritis, and erythrodermic psoriasis where 90% of the body becomes red and the person sheds skin in large sheets, requiring to be hospitalised.
