When she first started getting symptoms of psoriasis, Esther* thought she was having an allergic reaction. “I had small red patches of itchy skin along my hairline and had recently switched to a new shampoo, so I was convinced that was the cause.” She switched back to her old shampoo, but nothing changed.
“Then, the patches became dry and thickened. I thought the allergic reaction had damaged my skin and I just kept applying thick creams to it, but nothing really helped.” This continued for a few months, and Esther’s self-esteem continued plummeting during this time.
“In the beginning, I wasn’t all that concerned, but eventually I was checking my skin in the mirror every hour or so to see if anything had changed. It was awful having these patches around my face, such a visible part of the body, and I was embarrassed to be seen in public. Make-up also seemed to make it worse. I started going out less and less and avoiding my friends just made me feel even more depressed.” Then, new patches formed under her breasts. “I finally decided to visit a dermatologist and was diagnosed with psoriasis.”
What causes psoriasis?
Dr Ugeshnie Naidoo, a Gauteng-based dermatologist, says psoriasis is an immune condition that causes skin inflammation. It is not contagious and is not caused by bad hygiene. “Patients have a genetic predisposition and the disease then starts after a trigger such as stress, trauma, taking certain medications, an injury, smoking, or an infection – especially streptococcal throat infection.”
In Esther’s case, she believes the trigger was her family emigrating to the UK. “It was a very emotional time for me, and I felt incredibly alone. My symptoms started appearing around a month later.” Psoriasis is one of the most common skin diseases in South Africa and can happen to people of any age. One study in KwaZulu-Natal identified psoriasis in 12 out of 785 people.
How to recognise it
Dr Naidoo says psoriasis first shows up as red scaly skin. “These patches are well-demarcated and can occur in numerous patches scattered over the body, or one isolated patch. In acute cases, pustules (bulging skin with pus inside) can also appear, or a rash can cover most of the body. The most commonly affected areas are the scalp, buttocks and face.”
Psoriasis can sometimes be confused with eczema, which starts as fine, itchy blisters under the skin, she adds. “When these blisters burst and ooze, skin can heal in darker or lighter patches. In chronic cases, skin can become thicker and the markings can resemble psoriasis.” But psoriasis goes more than skin deep. “As an inflammatory condition, it often affects the whole system and symptoms can include joint pain (called psoriatic arthritis), cardiovascular disease and depression,” says Dr Naidoo.
Treatment options for psoriasis
Psoriasis is a lifelong condition, and although there is no cure, dermatologists can help treat the condition. Therapies include corticosteroid creams, vitamin D analogue cream, phototherapy and systemic immune therapy – including older immunosuppressant medications and newer biologic medications, says Dr Naidoo. Over-the-counter treatments that can help ease symptoms include creams containing urea, 2% salicylic acid, or tar.
Esther’s symptoms have settled since she started using medication and prescription creams. “I still have some patches, but it’s much milder and less visible. My mental health has certainly also improved!” There is hope, and it is possible to change the course of the disease, says Dr Naidoo. “The sooner we treat it, the more effective the outcome, and we can prevent the long-term problems associated with psoriasis.”
*Name changed to protect privacy
Additional sources: Janssen Pharmaceutical, American Academy of Dermatology Association, National Psoriasis Foundation US