Razib got a decent job soon after completing his graduation. But the young man was hiding a secret from his employer. He bore a skin condition called 'Psoriasis'.
Though not noticeable normally, it would become occasionally conspicuous. Inflated red areas would grow around his elbows and knees. They were itchy and painful. Sometimes they even bled. He went to the office wearing a full sleeve shirt under the hot summer sun.
His condition became unbearable over time. He took leave every so often, drawing the ire of his superiors. He didn't feel confident going out, concerned about what other people might think if they found out about his ailment. Sometimes he put on so many layers of clothing that he sweated profusely.
Razib's misery was far from over. He crumbled inside when his doctor told him that he had developed a heart condition. Depression and anxiety shrouded him. He thought his life was about to end.
Although Razib and his misery are imaginary, the horrors of psoriasis are not.
What is psoriasis?
Contrary to traditional belief, Psoriasis is not simply a skin disease. It's much more than that. Psoriasis can affect our life so overwhelmingly and can lead us to so many complications that calling it a mere skin disease would be a serious understatement.
Our skin is composed of two main layers: Epidermis and Dermis. The epidermis is the upper layer which consists of five sub-layers. The topmost layer is composed of dead cells. This is the part that we can see with the naked eye. Cells in the bottom layer are alive. In a physiological process, the top layer's dead cells are removed and replaced by the cells produced in the bottom layer. And as the cells move upwards, they lose their nucleus and eventually become dead cells on the top. This cycle is repeated approximately every 30 days. To keep things healthy, the rate of production has to keep a fine balance with the rate of removal.
So, what happens if this balance is compromised? This is exactly what happens in psoriasis. Instead of the normal 30-day timeline, cells in the bottom reproduce so rapidly that they come on the top every two to six days. This means even before the dead cells are gone, new cells continue to pile up underneath them. This causes areas of skin to rise from the surrounding. These are called plaques, which are generally reddish, with the dead cells forming silvery-white scales covering the raised area.
What causes it?
To tell the truth, we do not exactly know. But we do know it is an immunological disorder where some of our immune pathways are not working the way they should. And as a genetic disease, it tends to run in the family. But it has got a peculiar habit of skipping generations. So, the grandmother and the grandson may have psoriasis while the parents are completely healthy.
The disease usually follows a course physician called Relapsing and Remitting, which means a patient does not have any symptoms for most times, but other times they will suffer from an attack of psoriasis known as a flare-up. This may become severe. This may be caused by several reasons, like stress. In the case of Razib, the start of a new job and working on an urgent project may have led to stress-induced flare-up. A very common trigger for inducing psoriasis is throat infection, often known as a sore throat. Other triggers include injuries, cuts, burns, medications (e.g. anti-hypertensive drugs), etc.
Who are dealing with this?
Around the world, more than 125 million people are currently living with this terrible condition, which means approximately 3 per cent of the global population have some form of psoriasis. In Bangladesh, the exact number of people having this problem is not known, since there is no large-scale population-based study. But dermatologists see psoriasis patients quite often, so it is not quite uncommon.
The main issue with psoriasis is not the skin, but its far-reaching consequences. Psoriasis plaques are usually seen in elbows, knees, hands, feet, or even the face. Skin abnormality in these areas is often exposed to other people. In a country like ours, where physical appearance is considered very critical, such deformed skin is sometimes met with staring and demeaning comments.
Research shows that 75 per cent of psoriasis people feel that they are unattractive. This is compounded by the social stigma surrounding them. People shun them; do not invite them into events or parties even though the disease is completely non-contagious, and may even make sarcastic remarks about their appearances. That is why more than half of psoriasis patients fall into depression. They stop going out, interacting with people, and isolate themselves within the confines of their homes. Their financial future suffers. They lose jobs, friends, and their families. In extreme cases, people with psoriasis can even kill themselves, and such instances are not very rare.
Psoriasis patients are also more likely to get other diseases. It's not only psoriasis they should be concerned about, because they are at risk to develop arthritis, cardiac disease, or diabetes. So, their skin may look perfectly healthy, but their joints, heart, and blood glucose may not. Most psoriasis patients, in the long run, will develop at least one complication.
What is the remedy?
Well, this is a disease which, like diabetes, cannot be cured. But it surely can be controlled, so the flare-ups happen only after long intervals, and when they occur the symptoms remain mild. The first thing to do, if someone suspects of having psoriasis, is to contact a physician, usually a dermatologist. They will prescribe some treatments that can be applied to the skin. Sometimes Ultraviolet light therapy is prescribed which may give good results to some patients.
More serious cases require oral medications. Recently, new injectable medications have come up in the Bangladeshi market, which is more effective than previous medications, but a high price often deters their use.
Psoriasis treatment is not limited to individuals taking medicines; it requires family, friends, and society to take a hard look at them and empathize with the patient. The patient needs to feel included in the social gatherings and should not be laughed at or stared upon like they are carrying some sort of plague.
Creating awareness will require an understanding of the disease itself, and the impact of it on human life. Unfortunately, such awareness activities are few and far between.
Psoriasis is somewhat gender-neutral, as it affects both men and women almost equally. More importantly, it usually begins to appear when the individual is between 15-35 years of age, the most productive times of their life. So when these young people are at their prime, instead of planning for a bright future with a loving family, they are looking at a long road of coping with the illness.
They cannot be blamed if they think their life has ended. But modern medicine can help them control their condition, and with a supportive family and society, they can lead a life like any other normal human being. A concerted effort, therefore, is necessary for Bangladesh to make people aware of the burden of psoriasis and how all of us can tackle this menace.
References
Rendon, A. & Schäkel K. (2019). Psoriasis Pathogenesis and Treatment. International Journal of Molecular Science; 20(6): 1475
Armstrong, A. A. & Reed C. (2020). Pathophysiology, Clinical Presentation, and Treatment of Psoriasis. JAMA;323(19):1945-1960
The writer has completed MBBS from Dhaka Medical College. He can be reached at [email protected]
