PSORIASIS - IT’S HIGH TIME TO END THE STIGMA AND PAVE WAY FOR INCLUSIVENESS

One of the most commonly seen conditions in the dermatology OPD is psoriasis. This disease has spread its wings across many nations and indiscriminately attacks both men and women alike. The rise of psoriasis amongst our generation indicates that we need to step back and keenly observe our lifestyle and take corrective steps. Many fail to understand the true nature of this disease. I have observed that many avoid to touch and interact with these patients and socially discriminate them. It’s not a communicable disease, where once you come in contact with the affected individual, it spreads. Psoriasis is an autoimmune disorder, where our own body’s T-cells attack the keratinocytes present in the upper epidermis. Here what happens is that, the body mistakes the keratinocytes to be unknown antigens. Now they stimulate the Langerhans cells, which are a part of the body’s immune system. The Langerhans cells take them to the lymph node where the T-cells are stimulated. Now is where the problem arises. These T-cells attack our poor Keratinocytes left and right, along with that the basal cells of the epidermis will start dividing faster. Generally, in a normal individual it takes around 28-30 days for the skin to shed off and rejuvenate. But here it takes only 4 days which is against the law of nature. This rapid division results in hyperkeratosis and this is why we see the silvery plaques, a characteristic feature of patients suffering from psoriasis. 

Dermatologists generally perform an Auspitz test where they gently scrap the psoriatic lesion. By doing so they remove the stratum corneum which in layman term means the topmost layer of the skin. If they notice intermittent pin point bleed, it indicates that the test is positive and confirmatory lab tests have to be performed for managing the further course of treatment. In some cases, dermatologists will excise a small portion of the epidermis and send it for histopathological sampling. Munroe micro abscess, is a term used by pathologists while reporting, f they observe good amount of neutrophils densely accumulated around the startum corneum layer. They might sometimes report it as Kogoj spongiform pustules, is they observe the neutrophils in the stratum spinosum layer. In psoriasis, it is the epidermis of the skin which is mainly affected. The epidermis is further divided into 5 parts, namely stratum corneum, startum lucideum, stratum granulosum, stratum spinosum and stratum basale. In psoriatic patients Stratum granulosum is absent.

Steroids are the mainstay treatment for this disease. It is to be noted that systemic steroids are avoided and topical steroids are to be prescribed. The reason being when systemic steroids are stopped abruptly it can convert stable psoriasis to an unstable one, which manifests as pustular psoriasis and erythroid-dermic psoriasis. Other exacerbating factors are pregnancy, emotional stress, smoking, alcohol consumption, and sometimes infections caused by Streptococcus. Biological inhibitors are prescribed to inhibit the action of cytokines such as TNF-Alpha, IL-12, IL-17 and IL-23. Once inhibited these cytokines will not be allowed to increase the inflammation. For hyperkeratosis, very commonly Acitretin is prescribed which is to be taken orally. Sometimes depending on the severity of the disease drugs such as Methotrexate, Cyclosporine are prescribed. Phototherapy is an added treatment adjuvant. Secukinumab is a newly released drug in the market which is a IL-17 inhibitor. One of the major complications of psoriasis is that there is an emergence of metabolic syndrome and insulin resistance being the most common amongst them.

Conclusion - 

Community acceptance of people affected with psoriasis should be stressed upon. Role plays, awareness speeches are to be encouraged at Primary Health Centers and Urban Health Centers. Raising awareness amongst people will enable them to seek help along with early diagnosis and treatment. Diseases like these when identified early will help in improving the outcome of the disease progression. After all, psoriasis is one such condition which needs proper lifestyle modification, proper follow-up of treatment and lastly a very strong family and community support