There is a joke among doctors that dermatology – the treatment of skin conditions – is the easiest job in medicine. & # 39; Patients never die, call you & # 39; never at night and never get better & # 39 ;, as the saying goes.
To translate: skin problems are not serious and usually cosmetic – so there are never emergency situations. And because many of the conditions we treat are lifelong and incurable, it is – it is implied – extremely lucrative if you are in a private practice.
After having worked as a dermatologist for more than two decades, I would like to say that these are misconceptions that annoy me enormously. And to anyone who would believe these things, I would say, you have clearly never met a patient with psoriasis.
Readers remember Philip Marlow, the protagonist in Dennis Potter's TV series The Singing Detective. The character was a psoriasis patient, played by Michael Gambon, who was sent to a hospital bed covered with painful sores and tormented.
Such a serious case is rare. But today more than one million Britons are affected to a certain extent. In people with psoriasis, skin cells multiply ten times faster than normal speed. The excess cells accumulate on the skin surface and form red, raised, flaky plaques that can be painful.
Patients suffer for weeks or months from symptoms that may disappear with treatment to return later. And it is not & # 39; just the result & # 39; – Some forms of the condition are associated with a painful form of arthritis.
Those who watched The Singing Detective may recall particularly uncomfortable scenes in which Marlow's nurse, played by Joanne Whalley, had to smear his body in ointment to ease his discomfort
There are known links with high cholesterol, heart disease, diabetes, bowel disease and liver disease, and patients with severe psoriasis live on average four years less than healthy people.
To put that in perspective, you might see an even shorter lifespan for excessive drinkers. And because it is so visible, the disease can cause paralyzing anxiety, depression and insomnia. It can destroy relationships and employment prospects – one fifth of patients will have long-term sick leave at some point.
Studies have shown that about one in 15 people have considered suicide, and some are taking their own lives. So it is not true that patients & # 39; never die & # 39; to the disease. And yes, it is incurable. But that doesn't mean they & # 39; never get better & # 39 ;. We can do a lot to help.
Losing weight can keep the symptoms at bay
For some of my psoriasis patients, their skin condition is just one of many health problems. The disease can go hand in hand with obesity, diabetes and high blood pressure – a dangerous group of problems sometimes referred to as metabolic syndrome.
In a 2013 study with more than 70,000 women, those who were obese were nearly twice as likely as people with a healthy weight to suffer from psoriasis. Scientists are uncertain about the exact nature of this relationship. It is thought to be related to inflammatory processes, common with metabolic syndrome and psoriasis.
Fat cells have a number of functions, including releasing chemical messengers that help regulate the immune system. The more fat we have, the higher the levels of these chemicals. Over time this can cause problems – low level inflammation of important organs and blood vessels, increasing the risk of a series of diseases.
Inflammatory processes also occur in psoriasis and contribute to the rapid growth of skin cells. Studies show that for some people weight loss can help keep psoriasis symptoms at bay and I advise all my patients to stay at a healthy weight. It is just a simple step, along with medication and other choices for a healthy life, that can help them get their condition.
Since last week, psoriasis has found a new face – and body – in reality TV star Kim Kardashian-West
Face of the disease … Kim Kardashian
Since last week, psoriasis has found a new face – and body – in reality TV star Kim Kardashian-West. Famous for her normally flawless appearance, the 38-year-old published photos that show the extent of her skin problems.
Angry, flaky red & # 39; scabs & # 39; covered most of her lower leg, extending from above her ankle to just before her thigh. Another selfie showed a collection of crimson spots on her usually perfect face – all the classic psoriasis symptoms.
The mother of four had written a report of her illness and shared a cheerful message that she was comfortable & # 39; comfortable & # 39; was with it. But getting to this point can be difficult.
Our skin is what the world sees. And if there is something visibly wrong with it, people will notice it. There is a big prejudice: you cannot catch & # 39; psoriasis & # 39; or pass it on, but patients tell me harrowing stories of being chased from swimming pools or gyms and even being refused service in stores for fear of & # 39; spreading disease & # 39 ;.
Famous for her normally flawless appearance, the 38-year-old published photos showing the extent of her skin problems
Fortunately, because the number seems to have been affected, the understanding of the psychological impact of the disease is also increasing. Today there is a new specialty: psychodermatology, an amalgamation of dermatology and psychology.
We have a dedicated psychodermatologist at my clinic. She is known for starting her consultations by asking, "Tell me what was going on in your life when the skin problems started?"
Studies have linked stress and even childhood trauma to psoriasis. Although stress can cause a flare-up or psoriasis, there is always an underlying genetic reason for the disease.
One thing is certain: a patient's mindset is an integral part of how well they deal with the disease and how much it affects them.
Patients are often prescribed treatments that are related to skin symptoms. But ideally this would be combined with a form of speech therapy or mindfulness. In more severe cases, a course of anti-anxiety or antidepressants can also provide much needed relief from feelings of bad mood caused by the condition.
Problems in the most intimate areas
A little discussed aspect of psoriasis is how it affects intimate areas. For a patient of mine, the pain of her skin condition only strikes when she goes to the toilet. Instead of thickened, flaky spots of skin on her limbs, she has red, sensitive spots and cracks between her buttocks.
Some patients who come to the clinic find that their love life is seriously influenced by their symptoms.
They lack confidence and can really struggle to be intimate with their partners.
Another relatively unknown problem is erectile dysfunction. Patients with psoriasis are more likely to experience this problem than healthy men. This may have a psychological or physical cause, but anyway, it is important to tell your doctor who can refer you to a specialist.
Now offered more than ointments
I say to people: don't worry, I am not contagious
Lianne Hunter was diagnosed at the age of five
Lianne Hunter, 32, is a PR manager from Manchester.
She says: "I was 12 years old, swimming with my little sister in a local pool when an employee asked me to get out.
"They had noticed the spots on my skin and believed they were contagious. In fact it was psoriasis, a skin condition in which I was diagnosed at the age of five.
"When I was in my teens, the small spots that first developed on my skin became larger and spread everywhere.
"They were all over my scalp, forehead, ears, torso, legs, arms, under my nails and toenails.
"I really felt self-conscious – it got so bad I would tell people before they could say anything. I would say to everyone I met: "Hello, I am Lianne, I have psoriasis and it is not contagious." In recent years I also suffered from fatigue, a bad mood and really bad joint pain.
"The only time my symptoms disappeared was two years ago when I had a baby. Before that I checked them relatively well with food and exercise. But within hours of birth it came back, almost everywhere in my body.
"I'm currently using a steroid cream to treat my skin, but it doesn't really help that much. I am on a waiting list to see the dermatologist and hope for something stronger.
"It's great that Kim Kardashian is public about her psoriasis. Like them, I sometimes wear makeup to cover my patches. But sometimes not.
"I learn to feel comfortable in my skin. Perhaps that way the prejudice against people with skin problems will end. & # 39;
Those who have watched The Singing Detective can remember particularly uncomfortable scenes in which Marlow's nurse, played by Joanne Whalley, had to smear his body in ointment to ease his discomfort. That was then almost the mainstay of the treatment. In severe cases, patients could even be admitted to hospital until the plaques disappeared.
But things have gone further. We now have a large number of treatment options that are highly effective, but finding the right therapy can require some persistence.
The first port of call for mild psoriasis are special, thick moisturizers that are called emollients. They help the skin retain moisture, allowing it to heal, and they are applied to the affected area several times a day.
If these do not work on their own, we can give you recipe creams next to them.
Corticosteroid creams work by dampening the underlying inflammation in psoriasis. This slows the overproduction of skin cells and reduces itching. Vitamin D derived creams can be used alongside them, enhancing the anti-inflammatory effect. They work by slowing down the production of skin cells and reducing inflammation. Vitamin A-derived creams or gels are another type of common treatment.
Corticosteroid creams should not be used for too long as there may be side effects: over time, they can thin the skin and cause stretch marks. They must be used gently on the face and in intimate areas.
We also have newer recipe creams, also known as calcineurin inhibitors. There are currently two options, tacrolimus ointment, also known as Protopic, and pimecrolimus cream, with the Elidel brand. These work by suppressing the activity of the immune response in the skin, leading to the remedy of symptoms. Both can be used in the longer term, but are not effective for everyone.
There is also light therapy in which the skin is exposed to artificial ultraviolet rays under medical supervision.
The rays slow the growth cycle of the skin cells. Each session lasts a few minutes at most. It takes two to three sessions a week, sometimes a few months, for it to work. For some treatments, a medication called psorals can be given to make the skin more sensitive to light.
Some patients think that the use of tanning beds helps, but the machines used in the hospital are specialized and emit a completely different kind of light. I strongly advise against using sunbeds for psoriasis because they do not have the same benefits and can increase the risk of developing skin cancer.
New drugs can be life-changing
In recent years, new, innovative drug treatments have emerged. Pills that suppress immune responses that cause psoriasis, such as methotrexate or cyclosporine, have been used for a long time. Then came drugs called oral retinoids. These bind to skin receptors and normalize the rate of skin cell growth.
Most recently came the arrival of biological treatments. Unlike the old-fashioned immunosuppressive drugs, these, delivered through a puncture, focus their action on chemical messengers in the skin that are specifically responsible for inflammation.
Some, including one called etanercept, are also an effective treatment for other conditions – including certain types of arthritis.
These regular injections can be life-changing. A patient recently came to my clinic after his third round of injections. He had been a slave to his creams for more than ten years and left him with greasy hands. His work included a lot of paperwork that during an attack he was too scared to touch for fear of leaving oily spots.
Now he is unrecognizable. He thrives on work and on a promotion. Best of all, he has no psoriasis right now.
- Dr. Stefanie Williams is the medical director of Eudelo (eudelo.com), the dermatology clinic.
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