by Dr. Ramesh Bhat M
Psoriasis is one among the common skin diseases prevalent all over the world. It is a chronic immune – mediated skin disease with significant physical and psychological impact. The patient with psoriasis will also have profound effect on quality of life. Many patients will have tremendous effect on their social life also. The prevalence rate appears to be around 2 – 4 % in the western world, whereas in India it is around 1 -2 %. It is also alarming to note that the prevalence of the disease is increasing in developing countries also.
Psoriasis is considered as a disease with multifocal aetiology and pathogenesis, involves several innate and acquired factors. Various immunological factors have been considered and many of the newer drugs are targeting these cytokines.
The clinical manifestations are varied and there are many morphological types. Psoriasis may also affect joints resulting in psoriatic arthritis. Now a days psoriasis is also considered as a metabolic disease.
In developing and low econonomy countries many of the patients do not have specialist access to care for their disease. Many of these patients consult the Dermatologists only after a gap of many years. It’s always important to initiate the specific treatment in the early phase of the disease so as to prevent morbidity and incapacitating joint deformities.
The treatment of psoriasis has both topical and systemic options. As there is no exclusive curable treatment for psoriasis and arthritis, there are multiple options for the management of this disease. It is very distressing to note that, most of these medications are costly and many a times are not affordable by common people. Topical agents include application of moisturizers, coal tar ointment and vitamin D analogues. Even though topical steroids give temporary relief from symptoms their use should be restricted and under the supervision of Dermatologists. The traditional systemic medication like Methotrexate, cyclosporine and Azathioprine have to be administered under supervision in view of various side effects. The newer biologics therapy is quiet effective but most of these are unaffordable to many patients. The small molecules include Apremilast and J K inhibitors. Most of these medicines require prolonged treatment and supervision by experts. Although relatively high patient satisfaction scores are reported with biologics, costs and loss of response over time are the major drawbacks.
It’s very disheartening to note that treatment for psoriasis is not included under many of the government health schemes and insurance schemes. Considering the fact that treatment is prolonged and most of the medicines are costly it’s very important to support the patients with various insurance schemes. Currently International League of Dermatological Societies has recommended World Health Organization to include biologics under essential drugs. Even in developed countries biologics are not available through insurance schemes. Sometimes the insurance premium will be increased in subsequent years if biologics are prescribed.
Thus psoriasis can be considered as a chronic relapsing disease with profound impact on quality of life and can result in psychological impact in many patients. There is a dire need to support psoriasis patients for newer therapies, so that there is improvement in the quality of life.
Dr. Ramesh Bhat M, Professor & Vice Dean, Father Muller Medical College, Mangalore
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