Dumaguing: Know More about Psoriasis

FIRST and foremost, psoriasis is NOT a contagious disease. This strong statement hopefully, will remove, once and for all, the prevailing notion that psoriasis is a communicable and contagious disease, a misconception which has directly and indirectly put patients or if you may, sufferers of the disease, into pitiful situations like not being allowed to board a plane or eat in a high-end restaurant or even just being a seatmate in a classroom.

Second fact is that psoriasis is an inherited ailment. There is a trait handed down from parents to children, although not necessarily affecting all siblings. Genetic mutation has also been found to be a cause of the illness. The characteristic triad of psoriasis is thickening, redness and scaling. The extreme redness of the skin gives the impression to onlookers that there might be an infection, thus, their worry and eventual avoidance of close contact with the person.

The skin is now considered as the biggest organ in the human body, in terms of surface area. It has three layers; the epidermis being the outermost, serving as an effective protective barrier not only against microbes but also to harmful solar rays from the sun. The dermis is the middle, thickest and so-called vascular layer, whose blood vessels supply oxygen and nutrients to the overlying epidermis. The subcutaneous layer or tela subcutanea is made of fatty tissue, oleic acid being most abundant fat in it, colored bright orange-yellow because of the pigments carotene and xanthophyll. In normal, healthy individuals, it takes 28-30 days for the process of epidermidization - the replacement of the dead topmost layer of skin cells by new, young skin cells. In the case of persons with psoriasis, this process is much shorter that the skin cell turnover takes place within 3-5 days, thus resulting to an excessive accumulation of dead surface cells which later develop into scales and even bigger plaques. Dry and dead skins cells eventually slough off and shed leaving a fresh, reddish raw skin underneath the scales or plaques. Of course, itchiness or pruritus is a disturbing symptom which would make a person scratch the lesion and this invites infections especially with streptococcus and staphylococcus.

The author has been fortunate to watch the interview of Mr. Joseph de Guzman, President of Philippine Psoriasis Association and the doyenne of the VMV Skin Research Center, Dr. Vermen. M. Verallo-Rowell. The lady dermatologists, known both locally and internationally emphasized the two spikes of the occurrence of psoriasis in the lifetime of humans; the first being 18-25 years and the second spike when the person is 40-50 years old. There are sites of predilection; usually the scaling starts in the scalp, so much that dandruff or seborrheic dermatitis could be mistaken as psoriasis, although the amiable doctor said that the scalp scaling could be part and parcel of the disease. Skin folds particularly the knees and the elbows are also favored sites of psoriasis.

A whole body physical exam under natural light is imperative in the diagnosis of psoriasis, which could be mistaken as eczema, atopic dermatitis, or skin asthma. Contact dermatitis is the redness and inflammation of skin like earlobes wrist or fingers allergic to costume jewelries especially those containing nickel and alloy of metals. The treatment, although both Mr. de Guzman and Dr. Rowell were quite careful about declaring an absolute cure - depends on the extent of body surface involvement; less than 5 percent of the body would be mild, moderate if from 5-10 percent and severe if more than 15 percent of the body is involved in which, on top of the topical creams and lotions, the patient must take capsules or even receive injections to manage the signs and symptoms of psoriasis.

A very endearing and shall we say, nationalistic statement from Dr. Verallo-Rowell, who had extensive training abroad, extolled the virtues of our own coconut oil, especially if freshly-obtained. Zinc oxide applied properly serves as a skin barrier repair. While topical steroid creams significantly reduce the inflammatory skin reactions, Mr. de Guzman was quick to share experiences of his colleagues that more than two-weeks use could lead to thinning of the skin, making it susceptible to bacterial infection. Dr. Rowell encourages patients to get early morning sunshine, and swim in the sea preferably before 9 am and after 4 pm. Swimming pool has chlorine and hydrochloric acid in it so it may not be good for the psoriatic patient. Of course, for the real problematic cases, the cancer medicine Methotrexate or MTX is an effective last resort.

Dr. Verallo-Rowell clarified that a diagnosis of psoriasis is not as morbid as a death toll, sharing experiences with patients who, monitored regularly and obediently took their medicines, have had no flare-ups and in fact, brave and confident enough to walk down the ramp amidst glaring light of fashion shows or the scrutinizing close up on television interviews. More than that, she implored the public not to cast a disdainful look at persons with psoriasis but rather give them a compassionate, accepting and friendly smile.

Let's shake hands to that. Or better yet, why not a beso beso? Cheers!

Next Week: Let's hear it for deafness

Published in the Sun.Star Baguio newspaper on November 15, 2014.

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Dumaguing: Know More about Psoriasis