CHENNAI: Cuts on the soles of the feet were not abnormal for Anshika Nagar, who has experienced them since she was in class 4. The doctor she consulted then had diagnosed her with dry skin and vitamin D deficiency. But, when she began college in Pune and found her soles blistered, she knew it was time to revisit the dermatologist. One look at her condition and the doctor announced psoriasis — an inflammatory skin disorder and an auto-immune condition that is visible as redness, thickened skin, and excess shedding of dead skin. It commonly occurs on the scalp, hands, and soles of the feet.
The condition on the scalp is often mistaken for dandruff, mentions Dr KR Sharmatha, consultant – aesthetic dermatologist of SIMS hospitals, Vadapalani. Kritika* concurs, having made the same error herself. As someone with PCOS, dandruff had been a result of hormonal imbalance but soon enough, she realised that the condition was more chronic than she had expected. “I had plaque formation on my scalp that I would scratch by mistake and it would bleed. The flakiness and itching increased drastically, spreading to my eyebrows and earlobes too. That concerned me; I visited a doctor and was diagnosed with psoriasis,” she explains. According to Dr Sharmatha, there is a diagnostic criteria to distinguish general dandruff from psoriasis, part of which is the spread of the condition to other parts such as the lesions extending beyond the hairline, like Kritika’s case. “A patient can expect to have psoriasis of the scalp if there is a family history or if lesions are restricted to one part of the scalp. It is subjective but this is a simple way of identifying the same,” she elaborates.
When it comes to other parts of the body, there are various factors that indicate the need for a dermatological consult, shares Dr D Dinesh Kumar, dermatologist and secretary of International Society of Teledermatology. “There could be active lesions — meaning there is reddish thickened skin which is shedding scales. Active lesions may release inflammatory mediators in the body and without treatment, could damage the joints in the long run and cause psoriatic arthritis,” he informs. Where access to healthcare is difficult, one should consider teledermatology, he says.
Triggers & treatment
While the exact cause of the disease is unknown (apart from a mutated gene in the case of genetic occurrences), there are several triggers that can aggravate the symptoms. Stress is one, observes Anshika. “While working, I began seeing the cuts on my palms. I now know that if I am feeling stressed and getting a migraine and there are cuts on my hand, it is the body’s way of telling me to slow down,” she notes, adding that a poor diet (often due to stress) can also affect her. For Preeti*, the trigger is often stress, touch and weather. Her condition manifests as itchy patches across specific nooks such as knuckles, elbows, scalp. “It gets worse based on humidity and weather. The more humid the weather, the better since dryness makes my skin flake more. Ironically, moving from cold Canada to hot Chennai actually made it worse and that’s when I was able to identify stress as a major trigger,” she says.
Unfortunately, there is no known cure to the disease which, Dr Dinesh reminds, is the case for most illnesses (even the common cold). But, there are several treatment options that would allow one symptomatic relief. “There are various types of treatments depending on manifestation (and intensity). There are topical medications, immunosuppressants or biologicals to limit and control the disease,” says Dr Sharmatha. While it is important to seek treatment, it is also vital to maintain the skin when it is brought back to normalcy and this is where most people err or take for granted. As per Dr Dinesh, “There are many ways to prevent the lesions, but people have to be consistent. This requires monitoring, in terms of clinical tests and blood tests.”
Kritika’s psoriasis has been tamed with the help of Folli Tar shampoo and Preeti takes care by avoiding touch, and using soft soaps and hand cream. Anshika, too, maintains a routine of fragrance-free moisturisers and coconut oil, apart from prescribed medication. While home remedies and moisturisers may offer symptomatic relief, be careful with the same and check ingredients, remind the doctors.
Struggles and stigma
They may have found ways to ease their conditions, but the three still encounter difficult situations in their everyday lives. “Spending long hours in AC rooms or dry places can aggravate the condition and since I can’t freely scratch in public places, I often suffer there,” shares Kritika, and Preeti adds, “I find it hard to do household work since my hands and legs have patches. Washing vessels can be hard and cutting vegetables must be done carefully so as to not get any juice on my patches. Typing can be hard as well when I have open cuts or my flaking phase is bad.”
For Anshika, concerns extend to the long-term scenarios as well as she observes her aunt’s (who has psoriasis) condition. “My aunt had so many (lesions) in her palms that she couldn’t hold things, so I worry about that as well,” she says. Struggles apart, patients are often also met with unreasonable stigma, they share.
“I’d say it has affected my body image. When somebody points out something white or flaky on my hair, I get uncomfortable. Going to parlours for a haircut is a nightmare as well, as hairstylists bombard me with multiple questions and expensive solutions,” narrates Kritika.
Anshika, too, has resorted to wearing closed shoes. “I feel conscious when I have to go barefoot somewhere. Once I had many lesions on my palms and the shopkeeper was just staring as if it was contagious. He seemed only curious and I explained it to him,” she says.
Dr Sharmata, having encountered cases of stigma, signs off with an important message, “There are people in the society who respond adversely, and I think it is important for them to know that this is not a contagious condition.”
*Names changed
'On Auto Mode': This is a series on autoimmune disorders where we bring the voice of experts on the conditions, along with case studies of people who live with them.