Mental Health And Psoriasis

A few years ago, Vijay sat dejected in his room alone. A Bengaluru resident, Vijay was only 37 years old when he was first affected by psoriasis. Often perceived as a mere skin and cosmetic condition, psoriasis is in fact, an autoimmune disease with no cure.

Initially, Vijay assumed psoriasis to be like any other skin rash that would go away in time. However, as months passed by, the condition started to take a more serious form.

In psoriasis, the immune system mistakenly starts attacking healthy skin cells, accelerating the process of formation of skin cells. In a normal scenario, our body produces new skin cells that replace the older ones, in a cycle of every 10 to 30 days. However, in psoriasis, new skin cells form every 3 to 4 days, not allowing the body enough time to shed the older ones. This leads to a build-up on the skin’s surface in the form of raised, dry, itchy, flaky and red patches or silvery scales, commonly found on the elbows, knees and scalp.

For a year Vijay battled with psoriasis, especially at the workplace. Hiding the patches of the condition under long-sleeved shirts, avoiding conversations with colleagues and staying aloof behind his desktop at work.

At this time, Vijay also started trying various home remedies but to no avail. More time passed by and his frustration started kicking in. Soon, attending social functions and inviting guests at home started becoming a challenge.

He felt ashamed of stepping outside his home. However, at home, Vijay’s wife started keeping their two-year-old son away from him. She felt that as the disease was increasing in intensity, it could be passed on through touch to their child.

Three very long and miserable years passed by before Vijay was able to obtain a clear diagnosis of the disease.

Several medical experts are visited by patients who in their desperation for quick relief have turned to traditional healers. This often delays diagnosis for the patients.

Dr Maya Vedamurthy, Director, RSV Skin Clinic and Senior Consultant, Apollo Hospitals, Chennai says, “Psoriasis can cause stress and emotional trauma in patients living with it. The average time gap between the onset of symptoms and diagnosis is usually more than a year. Psoriasis is also stigmatized as being contagious and people suffering with it often start staying aloof, choosing this behaviour as a coping mechanism. It is important to work with a dermatologist to find the right treatment that works for you and fits your lifestyle. Treatment can reduce signs and symptoms of psoriasis, which usually makes a person feel better. With treatment, patients can aspire to achieve completely clear skin and experience a better quality of life”

In many instances, psoriasis can also be hereditary, and the gene often remains latent until triggered by an external factor. However, it is not necessary that one has psoriasis simply because their immediate

family member has it or even if you have the same combination of genes that someone living with psoriasis may have. The best option is to seek advice from a medical expert.

The treatment plan is determined as per the patient as well as severity and type of psoriasis. Advanced treatment options such as biologics are recommended for severe psoriasis.

Like Vijay, anywhere between 1 and 4 per cent of people in India suffer from psoriasis. In addition to the physical symptoms of the condition, in many instances, stress leaves a larger burden on the patient.

Dr Hozefa A Bhinderwala, Consultant Psychiatrist, Saifee Hospital, Mumbai says, “In my experience, I have witnessed 7 out of 10 psoriasis patients experience mild to severe depression. However, if we consider both anxiety and depression together in patients living with Psoriasis, then the number easily exceeds more than 90 per cent of patients. While anxiety and depression are the most common conditions linked to psoriasis, many other psychiatric conditions can coexist with the psoriasis-like obsessive compulsive disorder. Some patients can also develop psychosis (schizophrenia and Mania- Bipolar Disorder), as they are in denial and are reluctant to take medication.”

Psoriasis had a similar impact on Shirish. A 22-year old from Chennai, Shirish enjoyed playing basketball with his friends in his free time. Initially, when Shirish noticed signs of psoriasis, he chose to ignore it thinking it was a minor problem that would disappear on its own. However, with time, the condition became worse and made it difficult for Shirish to step out of his home, let alone play basketball and meet with friends. The frustration and stress of his appearance and what people might say about his condition led to Shirish slipping into depression. Unable to continue seeing her son’s condition become worse day after day, Shirish’s mom left no stone unturned. Eventually, she found out about a dermatologist.

Dr Hozefa adds “Involvement by caregivers remains significant and always makes the treatment more effective. Besides the medication and the psychotherapy, psychoeducation of the patient and family also play a crucial role in the overall therapy in psoriasis. Additionally, patients need to seek guidance from both a dermatologist and a psychiatrist. Their treatment should be customized keeping in mind their individual socio-cultural dynamics.”

After two years full of frustration which eventually led to depression, Shirish was able to get a clear diagnosis for psoriasis. With the correct diagnosis and treatment plan as per advice from a medical expert, Shirish was able to better manage his psoriasis. This combined with strong support from his mother, helped Shirish lift himself out of a depressive state. With his psoriasis under control, Shirish is currently busy with his wedding plans.