The hidden impact of psoriasis: more than a skin disease

• An estimated 200,000-plus people live with psoriasis in the Dominican Republic; however, there are no official figures and the level of underdiagnosis is unknown. Nor is it known how many patients are being treated or have their condition under control.

• 48% of patients report difficulty sleeping, 36% have problems using their hands, 35% lack energy for social activities and 29% report problems with their sexual activity in general.

Dominican Republic, October 2024 – Although psoriasis mainly shows itself on the skin, it goes much further. It is a chronic, inflammatory, non-contagious condition that can begin at any age and affects millions of people worldwide. Psoriatic disease brings with it comorbidities that deserve full attention, including a significant impact on patients’ quality of life, mental health, and financial and emotional stability.

Psoriasis is a systemic inflammatory disease that speeds up the turnover of skin cells, causing scaly plaques and red patches that itch and are sometimes painful. Most types of psoriasis appear in flare-ups that can last weeks or months and can subside or disappear if the necessary steps are taken. Although psoriasis has no cure, it can be controlled and people can lead a normal life.

A systemic inflammation that goes beyond the skin 

Psoriasis can appear at any time, although it is most common between the ages of 15 and 35. Factors such as stress, certain infections and some medicines often trigger lesions in genetically predisposed people.

Psoriasis is caused by an immune system disorder that produces widespread inflammation throughout the body. This affects other organs and parts of the body, including the nails, the palms of the hands and soles of the feet, the scalp and the skeletal system (including the spine and joints).

Psoriasis can also lead to serious problems such as psoriatic arthritis, cardiovascular disease, type 2 diabetes and obesity. This, together with the mental health problems caused by stigma and a heavy emotional burden, leads many patients to isolate themselves and even miss work, triggering episodes of anxiety and depression.  

According to a National Institutes of Health publication, 48% of patients report difficulty sleeping, 36% have problems using their hands, 35% lack energy for social activities and 29% report problems with their sexual activity. Patients with lesions on the soles of their feet also experience pain when walking or standing.

“Psoriasis is a disheartening disease that often does not receive the attention it deserves. It is a systemic, chronic, autoimmune condition with a high economic, social and emotional cost. It requires a multidisciplinary approach, an individual treatment plan and a commitment from patients to stick to their therapy and attend check-ups. It also requires the attention of health systems, since it is well known that interrupting treatment can have serious consequences for patients’ health, and also denies them the possibility of living a normal life.” So said Dr. Alina Hernandez.

Psoriatic arthritis affects 4 in 10 psoriasis patients

Psoriasis and psoriatic arthritis can begin at the same time. Less often, psoriatic arthritis can even exist on its own or before skin symptoms appear.

Some of the symptoms of psoriatic arthritis are: pain in joints such as the ankles, knees or elbows; swollen, painful or stiff joints; back pain near the spine; morning stiffness; swelling of whole fingers and toes; and pitted, crumbling or infected nails.

Psoriatic arthritis causes joint pain, stiffness and swelling and can lead to serious, permanent joint damage if left untreated.

Who should you see?

A dermatologist is the right specialist to diagnose and treat the disease. They can create a treatment plan that meets individual needs, including relieving symptoms such as itching, improving the appearance of the skin and referring patients to other specialists where appropriate.

As a systemic disease, psoriasis requires a multidisciplinary approach that may include a rheumatologist to treat psoriatic arthritis if it develops, as well as cardiovascular and mental health specialists, among others.

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