Winter is here! For many, it’s a season for festivities, family, friends and dry fruits and hot beverages to be shared together in the cozy ambiance. But for those having psoriasis, an autoimmune disorder that impacts the body's largest organ i.e. skin, it’s a roller coaster of countless highs and lows — physically and mentally as the disorder flares up during cold weather. The disease can be managed by lifestyle modification, proper medication, and meditation, doctors tell THE HEALTH PIONEER. Most important is not to stress as it can aggravate psoriasis, they say.
Psoriasis is affected by genetic factors, stress, pollution, viral, and bacterial infections that alter immunity. In psoriasis, a combination of these factors starts a process in which skin proliferates at a faster pace leading to the development of red scaly patches over the elbow, knee, back, and scalp. It's not known exactly why this happens, but research suggests that it's caused by a problem with the immune system.
A research review published in October 2018 in the International Journal of Dermatology has found that a large number of patients — anywhere from 31 to 88 percent — reported their psoriasis started within a year of a very stressful event. The authors of the study say the patients’ claims clearly suggest that stress may trigger the autoimmune disease in those who are predisposed to it.
Health experts too concur that Covid-19 induced stress has also led to the flaring up of psoriasis.
Dr. VK Sharma, Dean of Academic Affairs and Professor and Head of Dermatology, at the School of Medical Sciences and Research, Sharda University, Noida, UP said that we have also witnessed a spike in psoriasis cases during Covid-19. But, more studies are needed to conclude that Covid-19 can be the cause of psoriasis.
“However, winters do flare up the disease. Most of the patients who are in good control of the disease come to us in winter when it becomes more severe, symptomatic and itchy. It is important to note that like other diseases such as heart, and respiratory, Covid-19 infection too has impacted patients with psoriasis.”
Dr Sharma, the ex-HOD Dermatology AIIMS, Delhi, explained, “Inflammation caused by psoriasis can impact other organs and tissues in the body. People with psoriasis may also experience other health conditions. For instance, one in three people with psoriasis may also develop psoriatic arthritis (PsA). Signs of PsA include swelling, stiffness and pain in the joints and areas surrounding the joints. PsA often goes undiagnosed, particularly in its milder forms. However, it’s important to treat PsA early on to help avoid permanent joint damage.”
Dr. Gulhima Arora, Senior Consultant Dermatologist, Founder Director Mehektagul Dermaclinic, Delhi talked about the worldwide prevalence of the condition and the various organs of the body that gradually get affected if not managed in time.
“The worldwide prevalence is 0.1% to 3%. It can also affect the scalp, and nails in 40% and the joints in 10% -25% of the cases. With other organs involved, it is now considered to be a systemic condition. It is rare before the age of 10 years and most commonly occurs between 10-30 years of age.
“Typically, the rash of psoriasis is a raised lesion associated with white scales on top. The lesions may be of varied sizes and shapes, often prevalent on the elbows, knees, hands, feet, and back, but sometimes on the whole body. “The nails show “pitting” and the scalp has large white flakes with underlying redness, often mimicking dandruff. The most common joints involved are the small joints of the fingers and the spine which leads to pain and sometimes destructive arthritis. It is also associated with increased cardiovascular problems and psychological stress.
“The major pathology underlying this condition is excessive cell turnover and abnormal shedding of the skin cells of the uppermost layer. There are dilated blood vessels seen in a skin biopsy, along with increased cells known as neutrophils and lymphocytes. Psoriasis may be associated with triggers such as infections, stress, smoking, obesity and certain medicines like painkillers, antihypertensives and antimalarials.
Dr. Vikrant Choubey, Assistant Professor of Dermatology, Rama Medical College, Hospital and Research Centre, Hapur, Uttar Pradesh was of the view that the treatment of psoriasis encompasses medical intervention as well as general measures on part of the patient. “Patients not responding to conventional therapy may require a more advanced approach consisting of combination creams with salicylic acid or vitamin-D analogues, retinoids, oral immunosuppressives, phototherapy, or/and biological agents.
“During winters when the skin is prone to become dry and flaky, many patients report worsening of their lesions. Individuals with plaque psoriasis, therefore require frequent application of moisturizers, more so in winter. Besides it is advisable to avoid excessive scratching to cause trauma to skin as certain individuals have a propensity to worsening of existing patches or the appearance of new ones when any kind of trauma occurs. Avoiding any form of stress and keeping your diabetes, hypertension, and obesity under check could provide additional benefits" Dr Choubey noted.
According to Dr Vijay Singhal, Sr Consultant, Dermatology, Sri Balaji Action Medical Institute, psoriasis patients need to focus on few factors. “First of all, they need to be protected from any injuries. Sports and any other injuries can cause the Koebner phenomenon which refers to the emergence of new psoriatic lesions in healthy skin regions. This can flare up psoriasis. Hence, sports activities such as Hockey and other games which may cause trauma should be avoided.
“Secondly, psoriasis patients should avoid taking steroid injections or oral tablets. Sometimes less experienced or inexperienced doctors prescribe steroids but it is very harmful in the long term. Initially, these steroids might control psoriasis but later on, it flares up which is known as Pustular Psoriasis and patients may get high fever.
“Sometimes patients might need hospitalization. So, it is always better not to go for steroids and avoid any problematic conditions. Moreover, psoriasis patients should also avoid the beta blockers category of hypertension medicines. They should consult their physicians to have a different class of medicines for their blood pressure problem. We advise back pain patients to sit straight so that they can reduce doses of medicines including painkillers.
“Smoking and alcohol should be avoided completely as these two affect the liver. Because of this, we cannot prescribe a few medicines which help in controlling psoriasis.”
“Topical ointments, light therapy and medication can offer relief. Medical interventions including photodynamic therapy, medications, Vitamin A derivatives, Anti-inflammatory, and Immunosuppressive drugs do help in managing psoriasis. For such patients, Dr Singhal recommends a healthy diet, exercise, and stress management..
Dr Ramesh Bhat M, noted dermatologist and Vice Dean, FMM Mangalore, said that nearly two to three per cent of people in India suffer from this auto-immune condition as in the world. Patients come to us only when the condition flares up.
“That too when the exposed part is affected and hampering their day-to-day activities. Otherwise, they come very late to us. There are various types of psoriasis. In some types, the patients develop the disease all over the body parts,” said Dr Bhat. Multi-factorial problems trigger psoriasis. It can be stress-related issues, diabetes, hypertension, obesity or poor lifestyle. Early detection can ensure better management, he said while pointing out that the condition can not be cured.
An estimated 60 million people worldwide have psoriasis while in India, the prevalence varies from 0.44% to 2.8%.
Dr Bhat also pointed out that the overall quality of life of persons with psoriasis is significantly impacted. It is important their mental health well-being is also kept in mind while treating the disease. In fact, a study done in South India recently among psoriasis patients found the prevalence of depression and anxiety as 78.9% and 76.7%, respectively. Psoriasis patients are 1.5 times more likely to show depressive symptoms and experience a higher prevalence of anxiety symptoms (20–50%) than individuals without psoriasis, says yet another study published in ScienceDirect..
types of psoriasis
Plaque psoriasis (psoriasis vulgaris): Patches of psoriasis on someone's arm. Plaque psoriasis is the most common form of psoriasis. The plaques can be itchy or sore, or both. In severe cases, the skin around your joints may crack and bleed.
Scalp psoriasis: It is a type of plaque psoriasis. It can occur on parts of your scalp or on the whole scalp. It causes patches of skin covered in thick scales. Some people find scalp psoriasis extremely itchy, while others have no discomfort. In extreme cases, it can cause hair loss, although this is usually only temporary.
Nail psoriasis: In about half of all people with psoriasis, the condition affects the nails.Psoriasis can cause your nails to develop tiny dents or pits, become discoloured or grow abnormally. Nails can often become loose and separate from the nail bed. In severe cases, nails may crumble.
Guttate psoriasis: Guttate psoriasis causes small (less than 1cm) drop-shaped sores on your chest, arms, legs and scalp. There's a good chance guttate psoriasis will disappear completely after a few weeks, but some people go on to develop plaque psoriasis.
This type of psoriasis sometimes occurs after a streptococcal throat infection and is more common among children and teenagers.
Inverse (flexural) psoriasis: This affects folds or creases in your skin, such as the armpits, groin, between the buttocks and under the breasts. It can cause large, smooth patches of skin in some or all these areas. Inverse psoriasis is made worse by friction and sweating, so it can be particularly uncomfortable in hot weather.
Pustular psoriasis: It is a rarer type of psoriasis that causes pus-filled blisters (pustules) to appear on your skin. Different types of pustular psoriasis affect different parts of the body.
Generalised pustular psoriasis or von Zumbusch psoriasis: it is a rare and serious form of psoriasis that usually needs emergency treatment. It causes pustules that develop very quickly on a wide area of skin. The pus consists of white blood cells and is not a sign of infection.
Palmoplantar pustulosis: This causes pustules to appear on the palms of your hands and the soles of your feet. The pustules gradually develop into circular, scaly spots that then peel off. Pustules may reappear every few days or weeks.
Erythrodermic psoriasis: Erythrodermic psoriasis is a rare form of psoriasis that affects nearly all the skin on the body. This can cause intense itching or burning. Erythrodermic psoriasis can come on suddenly and may need emergency medical treatment.
What It's Like To Have Psoriasis
What patients need to know:
1) Psoriasis is completely manageable and it is for you to experience yourself by taking the right steps away from numerous medical prescriptions.
2) Self-counseling is a key to root-out psoriasis.
3) As stress, by far, is known to be one of the reasons to aggravate symptoms of psoriasis — first De-stress yourself by:
a) Yogic breathing exercises: Deep involvement in Kapal Bhati ,Anulom Vilom and Bhramari.
b) Asanas : Pawan Muktasan, Bhujangasan, trikon asan Butterfly, Mundook asan, Sashank asan, Hasth padasan and vipreetkarni (morning & evening).
These and other small everyday exercises would activate blood flow, and oxygen and generally calm down the body and mind when the patient is physically and mentally distressed by psoriasis scion, scaling and itching.
c) Deep meditation (Listening to various audio meditative practices available in YouTube - the one that suits your mood and temperament) would de-stress and in a large way resolve your sleep issues like irritation and mental distress.
4) Food: Firstly, the patients need to detoxify by taking a vegan diet and be gluten-free.
a) Juices: Take beetroot and carrot. Strict No to all citrus fruits and juices.
b) Salad: Cucumber, carrots, radish, small quantity of beetroot (after slight boiling)
c) Completely avoid meat, dairy products, nightshades ( brinjal, bell pepper- 'Shimla mirch'-), and citrus food.
d) Avoid: All refined and processed food including sugar. Substitute: jaggery, raisin, and dates
e) Include millet in your diet.
f) For protein: Include leafy vegetables, beans, lentils, tofu, and all kinds of nuts and seeds including flaxseeds ' white til and sunflower seeds, almond and walnut.
g) Millet fermented food: Ambli' would provide a holistic cure providing B 12 vitamins. More so, because psoriasis weakens gut health and liver, 'Ambli' will be of great help.
h) Include Omega-enriched food and seeds as supplements.
5) Sunlight exposure helps mitigate the condition. Go out in the open in the sun for 30 minutes.
6) Epsom salt bath for psoriasis scales only twice a week.
7) Don't take frequent baths as it dries your skin. Avoid soap.
8) Coconut oil application on the body and scalp to loosen dry sales. Dry skin could cause body discomfort.
9) Completely avoid alcohol, smoking, coffee, and tea.
10) Most important: Take charge, keep calm and be sure that ' this too shall pass before you could imagine.
11) Regular treatment: Non-conventional ' Ayurveda treatment' or homeopathy. Choose an authentic doctor who has treated psoriasis earlier.
