The skin, apart from being the protective covering that shields us from the environment, is a dynamic organ that periodically restores itself. New skin cells are constantly produced in the epidermis’ basal layer and as they move up towards the surface, they transform themselves to produce keratin and are eventually shed off. An immunologically driven alteration of the cell kinetics of these keratinocytes is the principal abnormality in psoriasis, a skin condition that affects millions of people worldwide..

Psoriasis is one of the most important skin disorders because of its frequency and recurrent nature. It is a chronic, debilitating skin condition that develops when the ordinary life cycle of skin cells accelerates. Instead of the usual four weeks, layers of skin cells are shed off in a matter of days. This causes a build-up of “silvery scales” on the skin, which are an almost constant feature of the disease. Psoriasis comes in many forms but typical lesions consist of sharply marginated, bright red, papules and plaques with silvery-white scales. These lesions are of various sizes and shapes and arise on different parts of the body. The most commonly affected areas are the scalp, elbows, knees, front legs and the buttocks–places most often exposed to pressure and trauma–often appearing on the same places on both sides of the body. Other areas of the body may also be affected like the nails, producing small pits on the surface. Some patients may develop arthritis. Itching may be prominent.

Despite advances in research, the cause of this condition is still unknown, although several factors are said to aggravate it: illness such as pharyngitis or sore throat, emotional stress, certain medications, as well as trauma secondary to rubbing or scratching may elicit more lesions. Men and women are equally affected by it. Psoriasis may occur anytime from infancy to old age, although it is commonly noted to begin during the second decade of life.

There are many myths on psoriasis. Although a percentage of patients do have a family history of psoriasis, we cannot predict who among the offspring of parents or ancestors with the condition will develop this disease, if at all. This author believes that psoriasis patients must not deprive themselves of the joys of life and of having children.

Psoriasis is not caused or exacerbated by food. There is no need to restrict the intake of certain foods. It is not infectious. Patients do not need to be isolated from other people.

To a certain extent, sunlight has proven to be beneficial in improving lesions of psoriasis. A fifteen to twenty minute daily exposure under the early morning sun from 8 t o 10 am may help. Intense and prolonged sunlight exposure may lead to sunburns, which may aggravate the condition.

Dermatologists frequently arrive at a correct diagnosis by means of a thorough history and physical examination of patients’ skin, scalp and nails. At certain times, a skin biopsy may have to be done to confirm the diagnosis.

Therapy of the condition is varied and is tailored to suit the individual requirements of every patient based on his or her health, age, lifestyle and the severity of the condition. Topical agents such as steroids, tar products, and synthetic vitamin D may be used by themselves or in combination with exposure to ultraviolet light either from the sun, or better yet, from artificial sources delivering controlled doses. For severe cases, oral medications may be needed to control psoriasis, such as methotrexate, retinoids and cyclosporine. New medications such as biologic immunotherapies have also been developed. It is important to emphasize the need to consult a dermatologist for initiation and maintenance of therapy, as these medications may produce side-effects if not used properly.

Although there have been many promising breakthroughs in the research of psoriasis treatment, currently, no treatment permanently “cures” it. Therapy is aimed at achieving improvement and remission of the condition, although recurrence is still likely. The greatest challenge, then, is to minimize the physical and emotional disability associated with psoriasis in a manner that is both effective and safe for the long term.

As John Updike—also a psoriasis patient– aptly put it, to have psoriasis is to have “the sense of another presence co-occupying your body and singling you out from the happy herds of healthy, normal mankind”. Truly, patients have a “sensation of anxiety and shame, a sensitivity acute beyond usefulness, as if the nervous system, flayed of its old hide of social usage, must record every touch of pain.” Because of the inextricable ties of physical appearance and the sense of personal identity, the psychological effects of this condition, coupled by its chronic nature and tendency to recur, are profound.

There are now several support groups in various hospitals and skin centers to address the emotional impact of the condition and the needs of patients to maintain a good quality of life. The National Support Association for Psoriasis Patients, Inc. (NSAPPInc) has also been established, and, in cooperation with the Philippine Dermatological Society, holds its National Assembly annually where a variety of topics and issues regarding the condition is discussed.

The search for better treatments continues. In the meantime, we urge our patients not to give up on life and their dreams.

Founded in 1952, the Philippine Dermatological Society (PDS) is the only recognized affiliate professional group for dermatology of the Philippine Medical Association and the Philippine College of Physicians.

The PDS Secretariat is at rm. 1015, Front Tower, Cathedral Heights Building Complex, St. Luke’s Medical Center, E. Rodriguez Avenue, Quezon City, with telephone number, 727-7309; and website, www.pds.org.ph.