Beyond the Skin
Written by Dato Dr RS Kumar.MBBS.FCGP, Fellow IAMS( Family Med)CCWC( Wound Care Certified) WWIC-Foundation -Wales) Certified Mental Health Practitioner-MSAP/UKM. Former Director of Medical Services-Qualitas Medical Group. Course Director.HRDF Accredited Trainer
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Dermatitis and Psoriasis represent two of the most prevalent, chronic, relapsing, immune -mediated inflammatory Skin Disorders worldwide. Beyond the Surface.
INTRODUCTION: Atopic
Both conditions are characterised by:
- Chronic Itch
- Recurrent Flares
- Sleep Disturbances
- Pain
- Negative impact -Self Esteem in Social Life.
- Sometimes risks of Mental Health issues.
PATHO -PHYSIOLOGY :
A) PSORIASIS involves a complex interplay of immune dysregulation, accelerated keratinocyte turnover inflammation and T-cell activation. It involves a complex interplay of Genetic, Environmental and Immunological factors leading to chronic inflammation and excessive skin cell growth. It is considered as a disease as well as an auto-immune disorder.
B) ATOPIC DERMATITIS OR ECZEMA is a chronic inflammatory skin condition with a complexpathophysiology involving genetic predisposition, skin barrier dysfunction and immune dysregulation surrounded by T-cell imbalance. Mast cells play a significant role in the allergic reactions releasing histamine and other inflammatory mediators. Atopic Dermatitis in contrast is not considered an auto-immune disorder.
PSYCHOLOGICAL ,SOCIAL AND ECONOMIC BURDEN:
Both Psoriasis and Atopic Dermatitis are common Skin Disorders that have profound social and economic effects on the Patients and their Families Studies of the effects of these Disorders have demonstrated their interferences with social life, sports, caring for the home, personal and sexual relationships and the ability to work in front-line social surroundings.
MANAGEMENT:Holistic Management Approach
1) Medical Treatment: Topical Therapies like Pine Tar and Systemic medications like long acting Anti-Histamines and Corticosteroids intermittently, most of which are mainly symptom driven besides monitoring skin hygiene.
2) Patient Education: Empowering through information and shared decision making, through life-style and self-care strategies.
3) Psychosocial Support : Patients with Psoriasis and Atopic Dermatitis face unique psychosocial challenges due to the chronic, visible and often misunderstood nature of their conditions. Here are the KEY area of support that will be needed :
- Peer, Family and Care-Giver Support – help reduce feelings of shame, isolation and stigma in the Community.
- Access to Mental Health Services - Stress and Anxiety Management.
- In extreme cases - support for Depression and Suicidal Ideation.
- Spiritual and Cultural Support.
CONCLUSION: Its all more than Skin Deep!
Psoriasis and Atopic Dermatitis can affect the entire well- being of a person, and not just the Skin alone,hence they will need a holistic support all the way.
Multidisciplinary Care is essential involving Dermatologist, Psychologist, Rheumatologist and Dietitian. There is definitely a need to reduce stigma promote awareness and increase holistic support.