Psoriasis affects patients more than skin deep

People may see psoriasis as having thick, red and scaly skin—not really different from an ordinary scratch or itch that could be cured with a dab of ointment. But for people like Josef de Guzman, psoriasis is more than just skin deep.

De Guzman is living with psoriasis, an incurable chronic disease characterized by red skin lesions appearing in different parts of the body. He currently heads Psoriasis Philippines (PsorPhil), a group composed of almost 5,000 psoriasis patients in the country.

“Kung mayroon kayong isang pimple sa mukha, alam niyo ‘yung feeling na parang ayaw niyo na lumabas dahil nakakahiya? Now, multiply that pimple to thousands—that is how we feel. That is what we go through every day,” he shared.

Living with psoriasis, de Guzman has been used to hearing some call him pangit, nakakadiri, galisin.

“Gabi-gabi naiisip namin, 'Bakit nga ba kami ganito?'” he said.

The disease affects two to three percent of the population globally, with an estimate of 125 million cases. In the Philippines, there are about one to two million people affected with psoriasis, de Guzman said.

Among those affected with the disease, 20 to 30 percent suffer from moderate to severe psoriasis.

Immune-driven

According to Dr. Maria Deanna Ramiscal, head of the photodermatology unit of St. Luke’s Medical Center in Global City, Taguig, psoriasis is an immune-driven disease.

She said psoriasis is attributed to the overproduction of messenger proteins by the immune system.

These proteins, known as cytokines, serve as messengers that coordinate the communication between immune cells in response to an infection.

One certain cytokine called interleukin 17A (IL-17A) is believed to play a key role in the development of psoriasis. Overproduction of IL-17A sends signals to skin cells, making them grow in number. This results to thickened skinned and plaque. And with the protein sending signals to infection-fighting cells, it causes inflamation, itching and redness of the skin.

“In psoriasis, skin replication goes beyond the normal. Mas mabilis ‘yung turnover ng skin, kaya you see scaling in the patients with psoriasis,” Ramiscal said.

What’s worse, Ramiscal claimed, is that IL-17A affects other body parts particularly the joints, which results to psoriatic arthritis.

“Thirty percent of the patients have psoriatic athritis, which can lead to permanent damage on joints, leaving patients severely debilitated,” she said.

The disease also triggers other comorbidities, the term used to refer to diseases and conditions that occur simultaneously with the present condition. Some of these comorbidities include diabetes, heart disease and stroke.

“It is not just a skin problem, it goes beyond the skin. A lot of patients have other organs affected by psoriasis,” Ramiscal stressed.

Hope for treatment

Ramiscal said there are traditional treatements for psoriasis including topical therapies, phototherapy and oral medication. However, these kinds of treatments affect the liver and kidney, and may even alter the way immune system works.

But there is a promising kind of treatment for psoriasis in the form of biologics, she said.

“When the medicine is injected to the patient, it targets precisely a single step in the process of developing psoriasis. Because it is a targeted therapy, the safety profile of this medication is better compared to the traditional oral medications taken orally which may affect other organs of the body,” she said.

These biologics, which are synthesized by living cells delivered through injections, block the IL-17A cytokine.

“We have to block IL-17A to stop the progression of psoriasis. It is the new potential target by the researchers. By blocking IL-a7A, we block psoriasis,” Ramiscal said.

One such biologic is a drug called secukinumab, which is effective in reducing almost 90 percent of the Psoriasis Area and Severity Index (PASI), a measure used to determine the severity of the disease.

The only drawback is the projected cost of the drug that may burden poor Filipinos living with psoriasis.

But more than all of this, psoriasis patients are also prone to psychosocial and psychological disoders.

“Most patients with psoriasis are likely to develop psychosocial and psychological disorder especially depression and anxiety,” Ramiscal said.

These psychological disorders may be brought on by the stigma the disease carries with it, as experienced by de Guzman and others living with psoriasis.

“Kinakaya namin ‘yung physical pain eh, pero ‘yung psychological pain mahirap siya labanan. Kung nadi-discriminate ka na ng mga mahal mo sa buhay, kunwari hindi ka niya nahahalikan. That’s the most painful,” de Guzman said.

.@JOSEFdeGUZMAN of PsorPhil shares his experiences as a psoriasis patient. @gmanews pic.twitter.com/9n8pGpkEzn

— Gerv Tacadena (@GTacadena) 31 May 2016

He said there are about 67 percent of psoriasis patients who have thought of suicide just to escape the shame public has continually thrown at them.

“A lot of us will choose a short-term life without psoriasis. That is how difficult for us to deal with this disease,” he said.

Raising awareness

De Guzman underscored how the lack of understanding regarding psoriasis is contributing to the stigma.

To address this problem, PsorPhil, along with the Philippine Dermatological Society (PDS), Philippine Rheumatology Association (PRA), and Novartis Healthcare Philippines, forged an alliance in helping spread awareness and education on the disease.

The stakeholders announced their collaborative project in a press conference on Tuesday in Quezon City. The project, with the theme Soaring Above Psoriasis, will include a photography contest for psoriasis patients.

Partner institutions present "Soaring Above Psoriasis" as the awareness campaign's theme @gmanews pic.twitter.com/3gA61rGmi4

— Gerv Tacadena (@GTacadena) 31 May 2016

“Showcasing their life in this photography contest would help Filipinos understand that a person with psoriasis is a very much normal individual, with the same joy, same sorrows and same challenges we all face,” PDS vice president Ma. Angela Lavadia said.

PRA president Heizel Reyes echoed the same statement. She said psoriasis patients contribute to society as much as people without the disease do.

“As rheumatologists, we are keenly aware of the pain and suffering that our patients go through in their everyday lives. Even as we are witness to our patients physical limitations, we also celebrate with them their victories at what they can become and what they achieve despite very chronic illness,” Reyes said.

“Lesions or no lesions, our patients are persons of beauty, they are persons of strength, they are persons who are victorious. They are persons who can soar,” she added. —KG, GMA News