PSORIASIS may not be as life threatening as heart disease, diabetes or cancer but its total impact can be just as debilitating. It is a chronic skin disease affecting 2 - 3% of the population. It is found in all age groups. Men and women are equally likely to get it. Although psoriasis may occur for the first time at any age, most people have the first symptoms between the ages of 20 to 30 years old. There are several types of psoriasis, ranging from mild forms on restricted skin areas to severe forms covering the entire skin surface. The disease often seriously compromises the quality of life of the affected persons.
Psoriasis is immunologically and genetically determined, with a multifactorial inheritance. It can be triggered in predisposed persons by a number of factors, including bacterial infections, trauma, psychological stress, certain drugs, certain diseases, alcohol and over-exposure to the sun.
Prof Dr P.C.M. van de Kerkhof … ‘ Generally, it (psoriasis) has a greater impact on a patient’s psychosocial status compared to the impact on physical activity’“Patients with psoriasis are faced with numerous misconceptions and social prejudices. These misconceptions exclude psoriasis patients from public facilities such as receiving equal service or treatment in hair salons, public pools and health clubs,” explains Prof Dr P.C.M. van de Kerkhof.
This was one of the key findings of a study published in the British Journal of Dermatology 2004, shared by Prof Kerkhof in his lecture titled Psoriasis – State-of-the-Art in Management at the 7th Asian Congress of Dermatology held in Kuala Lumpur recently.
Prof Kerkhof, who is the Chief of the Department of Dermatology at the University Medical Centre of St Radboud in Nijmegen, The Netherlands, is also a much sought-after expert on skin disorders and studies particularly on psoriasis.
The quality of life of psoriasis patients is affected to a similar degree to that of patients with other diseases, such as migraine and mild rheumatoid arthritis, according to the findings by him.
Psoriasis can take on many forms. The most common is well-defined coin-shaped red, thick and scaly patches which when scraped or scratched, show bleeding points. It usually appears on the elbow, knees and scalp but may also affect the upper body, joints and nails.
There are a variety of types but no matter what form it takes, psoriasis patients can feel very uncomfortable, both because of the itch, the look and the stares from an innocent but uninformed public.
The negative impact psoriasis has on the physical dimension of quality of life includes burning sensations, joint pain, itching sensations and scaling skin. Those aspects will have a negative impact on the mental dimension of such patients, such as being stigmatised and a generally depressed attitude on life, especially one’s social life.
“Generally, it has a greater impact on patients’ psychosocial status in comparison with the impact on their physical activities, although both areas can be affected,” explains Prof Kherkhof.
“Severe chronic skin conditions such as psoriasis can be described as ‘life ruining’ although it is not ‘life-threatening’ compared to other man-killers like hypertension, diabetes and cancer,” he adds.
It has also been found that psoriasis has a significant impact on sexual relationships and sexual activity. It can also impair the quality of life of families. Treatment time, reluctance to leave home or avoidance of public places may interfere with family leisure time.
Quality of life can be adversely affected by treatments that require a great deal of time and/or effort to take/apply, are “messy” in nature, are slow acting, induce unpleasant side-effects, and/or do not produce a “satisfactory” degree of response in a patient.
Last year, another study commissioned by the National Psoriasis Foundation (of the United States) was published in the Journal of Investigative Dermatology. The study revealed that even a “small” amount of psoriasis can negatively impact daily life.
Psoriasis presents a unique challenge to patients, doctors and society as a whole.Closer to home, the first preliminary work on a National Psoriasis Registry only started in 1998. According to the statistics from the Registry, major aggravating factors are stress and exposure to strong sunlight over a period of time. Most patients suffer from plaque psoriasis (73.5%). Drugs such as traditional medication, body-building supplements, antibiotics and others also worsen the condition.
According to the National Psoriasis Registry, out of 25,717 patients who consulted the Dermatology Department of Kuala Lumpur Hospital from 1995 to 1999, psoriasis was the fourth most common skin problem with 5.2% (1,344 patients), after skin infection, eczema and acne.
Although Malaysia is only beginning to track and learn the dynamics of the condition, it is hoped that the knowledge and learning will help experts to provide better assistance to other and new psoriasis sufferers.
