(LifeWire) - For Ninfa Cantu, the roller coaster known as psoriasis began with red, scaly patches on her scalp. Low points included a stint in a wheelchair when her entire body was covered with lesions; high points featured widespread clearance and normal-looking skin.
But Cantu, a 52-year-old San Antonio resident, knows better than to think she has beaten this autoimmune disease, which causes skin cells to turn over too rapidly and swathes the body with itchy, painful lesions. The fact is, psoriasis patients are never finished with this disease, even if they are in remission, because it is a chronic, lifelong condition with no known cure. Psoriasis promises only one thing: unpredictability.
"For people who say psoriasis is inconsequential, they've never dealt with it," says Leah Bird, 55, of Newton, Mass., who developed the disorder when she was 12 and also has been entirely covered by the effects of the disease at times. "When they learn more about it, they're blown away."
Some people with psoriasis - known as "psoriatics" who are numbering about 6 million in the United States - are relatively lucky, coping with a few small patches of affected skin that do not spread and can almost be ignored. But one-third of psoriatics find themselves with 20 to 100% of their bodies plastered with lesions, which may capriciously wax and wane. Emotions such as embarrassment, anger, frustration and desperation are likely to accompany the physical manifestations.
Not surprisingly, depression is a major issue for psoriatics. According to the American Academy of Dermatology, approximately 25% of psoriasis patients suffer from depression, which can be accompanied by symptoms that include constant fatigue and irritability, social withdrawal, difficulty sleeping and changes in appetite and sex drive.
Depression itself can worsen existing psoriasis and cause new flares, as the stress hormone cortisol affects the immune system. Other psoriasis triggers include cold and dry weather, smoking or heavy alcohol consumption, several medications (including ibuprofen) and certain infections, such as strep throat.
Depression and desperation also make it difficult to cope with the ongoing demands of psoriasis treatment, not to mention the emotional demands that come with having a visible problem that often requires patients to explain to others what those red spots on their skin are.
For Jared Brickman, coping means spending more time alone. The 22-year-old Syracuse, N.Y., resident has already experienced the failure of several psoriasis treatments, including topical creams and phototherapy, since his initial diagnosis in late 2007.
Consequently, his short-term career plans include working from a home office - not only to avoid the stress of visible psoriasis patches but also to avail himself of other treatments on a more flexible schedule than he would have if he worked in a conventional office.
"I don't think my friends really understand the emotional detriment [psoriasis] has, and they probably think I'm just being a jerk by spending so much time alone," Brickman says.
Other available treatments for psoriasis are pills or injectable medicines called "biologics." Psoriasis treatments all work to hinder the immune system's overproduction and inflammation of skin cells.
In lieu of more solitude, psoriatics should be encouraged to seek and develop the emotional endurance needed to cope with their disease.
Some tips include:
- Connect with others: Find a support group for psoriasis patients or a counselor with experience treating psoriatics. Airing and sharing feelings and experiences may help patients learn how to cope.
- Exercise: A proven stress-buster, exercise also releases feel-good chemicals into the body called "endorphins" and improves body image.
- Plan fun outings: Stimulating activities can refocus patients on what is going well in their lives and take the focus off bad moods.
What if none of these self-directed actions works? Seek a doctor's help, says Doris J. Day, MD, clinical assistant professor of dermatology at New York University Medical School.
"When you don't want to socialize or go for a job offer, when you can't get yourself up and out in the morning," Day says, "it's time to see a physician."
Sources:
Doris J. Day, MD, clinical assistant professor, NYU Medical School. Telephone interview, 16 May 2008.
"Double Diagnoses: Psoriasis and Depression." Psoriasis.org. Apr. 2005. National Psoriasis Foundation. 30 May 2008 <http://www.psoriasis.org/enews/200503_depression.php>.
Jared Brickman, Syracuse, NY. Telephone interview, 24 Apr. 2008.
Leah Bird, Newton, MA. Telephone interview, 15 Apr. 2008.
Ninfa Cantu, San Antonio, TX. Telephone interview, 24 Apr. 2008.
"Research Shows Patients with Psoriasis at Increased Risk for Developing Other Serious Medical Conditions." American Academy of Dermatology. 24 Mar. 2008. American Academy of Dermatology. 3 Jun. 2008 <http://www.aad.org/media/background/jaad/jaad_study_psoriasis_3_>.