Busting myths of psoriasis

As part of its World Psoriasis Day activities, the South African Psoriasis Association (SAPSA) is holding a walk along the promenade in Cape Town, from Mouille Point lighthouse to Sea Point pavilion and back. Open to the public, the walk is approximately five kilometres and will start at 10am.

"We would be delighted if people could spare an hour or two to join us for what should be quite a fun outing and to show their support," enthuses Judy Wallace, Chairperson of SAPSA. "Although it will be a pleasant, enjoyable stroll, our message is very serious."

The theme of this year's World Psoriasis Day is "Let's talk about psoriasis and take action", emphasising the urgent need to educate each other about this stigmatised condition and Wallace is quick to explain why psoriasis is a terribly difficult disease to live with: "Sufferers not only have to endure great physical discomfort and pain in severe cases of psoriasis," she explains, "they also have to put up with other's stares and often rejection. People mistakenly think it's a result of poor hygiene or that it is contagious."

"We need to do all we can to help end the stigma and discrimination people with psoriasis suffer," maintains Wallace, "so please join us to commemorate the day and show sufferers that you care."

What is psoriasis?

According to the National Psoriasis Foundation of America, around 125 million people worldwide suffer from psoriasis and experts suggest that just over 1 million of those are South Africans. "The prevalence of psoriasis around the world is approximately 2% of the population," confirms Dr Robert Weiss, President of the Dermatology Society of South Africa, "and we can fairly confidently assume ours is no different."

Psoriasis is a skin disease associated with the immune system. The immune system causes skin cells to reproduce too quickly and, instead of falling off (shedding), the over-manufactured cells pile up on the surface, forming red, scaly and often very itchy lesions or patches on the skin. Psoriasis is most likely to develop in adults in their 20s and 30s, but it can occur at any age.

The condition is classified according to its visual appearance, the location on the body where it usually develops and how much of the body is covered (severity). There are five different types of psoriasis: plaque; guttate; inverse; pustular, and erythrodermic. The most common of these is plaque psoriasis, accounting for up to 80% of cases.

"Plaque psoriasis forms the bulk of the cases we see," corroborates Dr Weiss, "usually mild to moderate in severity and extent, and developing in areas that are regularly subject to skin damage and wear, such as the elbows and knees."

The exact cause of psoriasis remains unknown, but researchers have found that a genetic link can be established in around 25% of cases (i.e. there is a family history of the condition) and that outbreaks can be triggered by a variety of factors, including severe throat infections, certain medicines, heavy drinking, stress and damage to the skin.

Stigma is the biggest challenge

The physical discomfort of the condition can be testing enough, but many sufferers identify the stigma and psychological challenge as the biggest ordeal. "The physical discomfort and itchiness can be unbearable," notes long-term patient Sue Calf, "and it's frustrating not being able to wear certain clothes or shoes and to always be looking out for what is in skin products, make up and shampoos, but being ostracised and teased mercilessly as a child was much worse."

"This aspect is often underestimated, but psoriasis can be psychologically devastating because it's so visible," explains Dr Weiss. "The stares, the rejection and the embarrassment sufferers experience have an understandably huge impact on the individuals and their families. Unsurprisingly, a large number of psoriasis patients also suffer from depression, alcoholism and obesity."

New treatments offer some hope

Although psoriasis remains choric (long-term) and incurable, a lot of progress has been made in terms of the range and effectiveness of treatments available. The condition can be treated in a variety of ways, including through the use of topical creams and ointments, light therapies (UVA and UVB) and systemic medications.

"Psoriasis is a condition that can be managed and controlled reasonably well with the new modalities available," affirms Dr Weiss. "A particular cause for hope in severe cases is a new group of drugs called 'biologics'. Currently, there are three registered for use in South Africa that offer excellent results and rapid clearing of disease."

Common myths and misconceptions about psoriasis:

1. Psoriasis is contagious - you can't "catch" psoriasis from another person
   
2. Psoriasis is caused by poor hygiene - cleanliness has nothing to do with it, the disease starts way below the surface of the skin
   
3. Psoriasis is a 'cosmetic' problem - aside from the physical pain and discomfort, sufferers also experience emotional and psychological anguish
   
4. Psoriasis can be cured - it may flare up and then clear, but the condition is chronic (long-term) and incurable
   
5. Psoriasis cannot be treated - existing and exciting new treatment options can help control and manage the symptoms
   

To learn more about Psoriasis or World Psoriasis Day, visit the South African Psoriasis Association (SAPSA) website at www.psoriasis.org.za.