“There are certainly more than 200,000 patients with psoriasis in Portugal”
AN psoriasis is a chronic, inflammatory, autoimmune and systemic disease estimated to affect 125 million people worldwide, of which around 14 million in Europe. In Portugal, data from the Portuguese Psoriasis Association (PSO Portugal) show that the disease affects more than 200 thousand people. However, a theory now emerges that the number may be much higher.
In an interview with Lifestyle by the Minute, Luiz Leite, a specialist in Dermatology at the Laser de Belém clinic in Lisbon, believes that there are “certainly” more undiagnosed cases in the country. The doctor also warns about the high rates of depression and anxiety, low self-esteem and impacts even on intimacy.
How many cases of psoriasis are diagnosed in Portugal?
There are statistics that indicate that an incidence of psoriasis can reach 6%, that is, three times more than the 2% that we know and that corresponds to 200 thousand patients with the pathology. However, there are those who do not seek medical help, so we are unable to obtain concrete data.
There are forms of subclinical psoriasis that people have, discrete, so they don’t know they have psoriasis or forms of obligatory psoriasis that are labeled with other diseases. There are forms of psoriasis only in the nails, which lead people to interpret that they have fungi and, therefore, they treat them with antifungal agents and, among others, forms of psoriasis in the genitals, which are confused with candidiasis. Thus, a 2% calculation that we are aware of does not correspond to reality. It’s superior. There are certainly more than 200 thousand patients with psoriasis in Portugal.
© DR
Usually a psoriasis is triggered in young adults, which does not mean that it does not appear in old age
And does the rate of psoriasis vary between men and women?
Psoriasis affects men and women equally. However, there are forms of psoriasis that arise in childhood and adolescence. Usually, psoriasis develops in young adults, which does not mean that it will not appear in old age. There are cases of people in their 30s who seek medical attention because they have natural symptoms. On the other hand, there are still cases in the descendants that appear earlier than in the rest of the family. There is a genetic predisposition, but not always visible.
What are the causes of psoriasis?
Psoriasis is an inflammatory disease, so it is still debated whether or not it is an autoimmune disease – although the tendency is to think that it is an autoimmune disease with a genetic predisposition. We know that some infections can be the trigger, but psoriasis is already there.
There are certain medications that can serve as a ‘triger’ factor for psoriasis.
What distinguishes a psoriasis? Does an inflammation only affect the skin?
The images we see on the skin are the tip of the iceberg. There are cases in which we cannot observe the skin and they are forms of psoriasis with joint complaints, although the anti-inflammatory process is systemic, because there is inflammation throughout the body.
There are also comorbidities that are associated with psoriasis and that are psychic hypotheses, such as depression, anxiety and alexithymia. A psoriasis has a strong impact on a patient’s life. A familiar level, it can be catastrophic. There are, for example, cases of alcoholism, domestic violence, successive absences and absence from work. And there are still other hypotheses, such as obesity, diabetes, inflammatory bowel disease, coronary heart disease, fatty liver, cholesterol, triglycerides, among others. It doesn’t mean that they all appear, but in different stages of the disease they can manifest themselves.
Is there medication that triggers psoriasis?
There are certain drugs that can serve as a ‘triger’ factor for psoriasis, namely anti-inflammatory drugs, lithium (used in depression), steroids or even alcohol and tobacco.
Is it possible to prevent the disease?
No, as psoriasis is there and can appear at any time in life. Even so, after diagnosis, it is possible to approach the disease effectively, with the objective of providing quality of life for people. Nowadays, this is possible because we have at our disposal a good therapeutic arsenal.
There is still a great stigma that leads part of society to believe that psoriasis is a contagious disease
What treatments are there?
Each case is different. But I would like to emphasize that biological treatments are, at the moment, the safest and most effective. Despite being expensive, it is not for what it will, in the future, offer to the person’s life.
And can a full or almost full skin treatment be achieved?
Today we can achieve 100% effectiveness. Still, we can have cases where the effectiveness is 90% and the bad ones 75%.
In practice, what are the most frequent complaints?
A form of psoriasis with joint complaints can cause joint pain and stiffness. Another one with very extensive skin lesions makes people have a very limited social life, not wanting to leave home and even socialize with other people. Then there are very particular forms of psoriasis, such as psoriasis located on the genitals. In the life of a couple, this has an impact that, in many cases, leads to separation. Currently, there is still a great stigma that leads part of society to believe that psoriasis is a contagious disease, which is not true.
What myths are there associated with psoriasis?
Contagion and the eventual disgust that people feel.
In Portugal, what work can be done to increase and improve knowledge about psoriasis?
A lot and I explain why: as long as we give priority and airtime to football health protection, we’re not going anywhere.
Does Covid-19 carry increased risks for these patients?
No. For example: at the Laser clinic in Belém we have about 800 patients undergoing therapy with biologicals. Of those, eight had Covid-19 and no problems were identified.
And in pregnancy?
A person who wants to become pregnant and who is undergoing treatment with a biological, has to interrupt and only after pregnancy can return. However, whether or not psoriasis worsens during pregnancy is variable because it can occur as two situations.
Also Read: Psoriasis and Eczema. How do they differ?