Understanding the True Burden of Psoriasis

✍🏻 Lau Sze Yi | PhD Chemistry Graduate from the University of Oklahoma

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What is psoriasis? 🩺

Psoriasis is not contagious.

Psoriasis is a lifelong, debilitating disease that results from an overactive immune system. Its most distinguishable symptom is psoriasis plaques, which appear as thick, red, scaly patches that can be itchy and painful. The immune system, which normally fights against harmful invaders, attacks healthy cells instead. Faulty immune signals in the skin prompt cells to grow uncontrollably, resulting in the build-up of multiple layers of skin cells.

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What causes psoriasis? 🔬

Both genetics and environmental factors contribute to the development of psoriasis.

As yet, scientists cannot pinpoint the exact cause of psoriasis, as it involves a complex interplay between multiple factors. They have discovered over 80 genes that make a person more susceptible to psoriasis. However, the disease cannot be solely explained by genetic factors. Despite carrying these genes, many individuals may not develop the condition. Environmental factors play a crucial role in triggering the onset of psoriasis in predisposed individuals. These factors include:

• Mental stress

• Obesity

• Diet

• Skin injuries

• Infections

• Certain medications

• Smoking and drinking

These triggers can drive epigenetic changes to DNA, influencing how genes are expressed. Scientists have yet to decipher the exact mechanisms and relative contributions of genetics and environmental triggers in the initiation and progression of psoriasis.

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Who can get psoriasis? 👨‍👩‍👧‍👦

Anyone can get psoriasis.

However, it tends to occur more frequently among adults and is distributed equally among both genders. As many as 60 million people worldwide suffer from psoriasis. The number of people affected by psoriasis varies significantly depending on geographical locations, with the lowest rates found in East Asia and the highest in Australasia and Western Europe.

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What are the symptoms of psoriasis? 🔍

Symptoms differ significantly from person to person.

The spectrum of symptoms spans from the appearance of rough, red scaly patches on the skin to pus-filled bumps, and can affect multiple locations on the body. Psoriasis can be classified into five main types:

• Plaque psoriasis

• Guttate psoriasis

• Pustular psoriasis

• Inverse psoriasis

• Erythrodermic psoriasis

Plaque psoriasis is the most common type, characterized by raised, red patches of skin with silvery-white scales. 80% of those affected have this condition, while symptoms may vary, itching and pain are commonly experienced, and in severe cases, bleeding may occur.

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How is psoriasis treated? 💊

Psoriasis is a lifelong condition with no cure.

Available treatments help ease psoriasis symptoms and are prescribed based on disease severity. These include:

• Topical therapies

• Phototherapies

• Systemic therapies

Disease severity has traditionally been assessed by how much the body surface area (BSA) is affected:

• Mild (affecting less than 3%)

• Moderate (affecting 3-10%)

• Severe (affecting more than 10%)

However, relying solely on BSA as a metric for disease assessment turns out to be inadequate, as it poorly predicts the impact of the disease on patients' functioning and well-being.

Patients who are classified as mild by the BSA metric can have a disproportionately worse quality of life. For example, persons with psoriasis on their hands and feet will struggle even with walking, standing, or doing basic hand-related tasks. Likewise, those with psoriasis on their genitals will have trouble engaging in sexual activities. Yet, based on BSA criteria, these individuals may be denied treatment that can help alleviate their suffering.

With a focus on considering factors impacting quality of life and addressing patients' needs effectively, the International Psoriasis Council has put forward the following assessment criteria:

• 10% or more of the body surface

• Sensitive body areas (hands/feet, genitals, face) impacted

• Topical therapy failed

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How does psoriasis impact function and wellbeing? 🤸

Psoriasis adversely impacts all facets of quality of life, including psychological, social, sexual, and occupational aspects.

Due to the visibility of disfiguring skin lesions, individuals with the condition often encounter discrimination and stigmatization. The public's misconception that psoriasis is contagious and is the result of poor personal hygiene plays a role in the stigmatisation of patients, leading them to feel socially inhibited. Struggling to manage the numerous emotional and social challenges, individuals with psoriasis can become susceptible to:

• Poor body image

• Anxiety and stress

• Depression

• Substance abuse

Moreover, discomfort due to itching and pain can disrupt sleep and restrict movements, resulting in a significant decrease in productivity. Many lost jobs because of disability or missed days at work to manage symptoms.

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What other health risks does psoriasis pose? 🚑

Psoriasis is a disease that affects the whole body.

Individuals living with psoriasis are at risk of developing significant health complications. The faulty immune system that causes damage to the skin can also infiltrate other areas, triggering many health complications including:

• Psoriasis arthritis

• Cardiovascular diseases

• Metabolic diseases

• Gastrointestinal diseases

• Malignancies

• Infections

Patients, especially those with severe forms of psoriasis may live with multiple health conditions. As many as 20-30% of people with psoriasis also suffer from psoriatic arthritis, characterised by swelling of the joints in fingers and toes that can be painful. Psoriatic arthritis can cause irreparable damage to the joints and bone, leading to significant functional disability and worse health outcomes.

Early diagnosis is critical for patients to access the right treatment. A number of predictive factors for developing psoriasis arthritis include:

• Nail, inverse, and scalp psoriasis

• Disease severity

• Family history of psoriatic arthritis

Patients with severe forms of psoriasis have a 50% higher chance of developing cardiovascular diseases with heart attack and stroke being the primary causes of death.

Cardiovascular risk factors such as hypertension, hyperlipidemia, obesity, and diabetes are often underdiagnosed and undertreated. To effectively treat and manage psoriasis, a broader approach that takes into account not only skin-related issues but also all relevant health risk factors is needed.

Proper assessment and early diagnosis will give psoriasis patients access to adequate treatment and support needed to cope with the disease and prevent serious complications.

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Edited by: Nori Otis (Content Editor)

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