Psoriasis: patients have a high rate of mental disorder – 10/29/2023 – Balance and Health

Social media analyst, Luana Cianci, spent her childhood and adolescence feeling out of place with her colleagues. She wore high-necked, long-sleeved blouses, even in the heat of the summer in Ceará, where she moved with her mother and stepfather at age 9. Tall and thin, she covered her arms to hide the injuries from a condition she still little understood.

The father, who was a pharmacist, helped with a consultation with a dermatologist at Hospital das Clínicas, in São Paulo, where he was diagnosed with psoriasis. At the time, he gave her a folder with documents explaining the condition, but she didn’t think much of it.

After going through a period of difficult acceptance, at the age of 15, he had a new crisis with injuries. She felt alone and couldn’t fit into groups of friends. At 17, she tried to take her own life. “There, I was reborn. I was hospitalized for a week and decided: either I accept myself, and I accept my own skin, or this isn’t going to work,” she says.

Now, at 28 years old, he is proudly participating in his 7th campaign for World Psoriasis Day, this Sunday (29). Although Luana is already considered a patient in remission, the stigma associated with her symptoms still leads many to delay the diagnosis.

Psoriasis is a systemic, inflammatory, chronic and autoimmune disease, which causes thick reddish plaques on the skin, covered by whitish or silvery scales. It affects 1 to 2% of Brazilians, or around 5 million people, according to the Psoriasis Brasil association. There is no difference in prevalence between men and women.

The most recent understanding is that it has a genetic component, which may be hereditary, but is also triggered by environmental factors. In general, the disease has two peaks, one in early adolescence and the other between 40 and 50 years of age, explains dermatologist Aline Bressan, master in medical sciences from Uerj (State University of Rio de Janeiro) and member of the SBD (Brazilian Society of Dermatology).

“What comes to the office a lot are patients who have given up because they were told that it is an illness with an emotional background, that it is their fault. It is not like that. Stress, anxiety, are aggravating factors, as well as obesity, smoking, and psoriasis itself can also be a risk factor for cardiovascular disease and hypertension,” he says.

The disease is not contagious, but many patients suffer from prejudice and discrimination in society. “They report that there is always someone who changes seats in the room or on the bus so as not to sit next to them. There is a lack of knowledge among the population about psoriasis. At work, they may be drawn to attention when wearing a black uniform or clothing, as scales, especially on the scalp, look like thick dandruff, so it’s a delicate situation”, he says.

In psoriasis, due to an exaggerated immune response from the skin itself, cells in the dermis accumulate and flake off, which can cause inflammation and even bleeding. In general, the lesions are located on the scalp, knees and elbows, and can also appear on the nails and other areas, such as armpits.

According to Marcelo Pinheiro, rheumatologist and member of the Spondyloarthritis Committee of the SBR (Brazilian Society of Rheumatology), around 30% of psoriasis cases are serious and can progress to the so-called psoriatic arthritis (when it affects the joints), pustular psoriasis and others, in addition to being a risk factor for other conditions, such as obesity and metabolic syndrome.

“We no longer call it psoriatic arthritis, because we understand the disease as a whole. Patients’ symptoms are very complex, they range from complaints of back pain to weight gain, changes in the digestive tract, mood changes, all related to inflammation of the body [da psoríase]. Therefore, a multidisciplinary approach to treatment is essential,” he says.

It is for this reason that many patients with psoriatic disease also have a high degree of depression and impaired mental health, explains the doctor. “They are at high risk for depression, anxiety and stroke [acidentes vascular cerebral]. And factors such as smoking and consumption of ultra-processed foods worsen the psoriatic condition.”

Changing your diet, reducing the consumption of highly inflammatory foods, such as carbohydrates, sugar and ultra-processed foods, is one way to help with treatment. Practicing physical activity and exposure to the sun also contribute.

“If you undergo bariatric surgery, you reduce the risk of psoriasis also progressing to a severe form by two to three times. So you need to understand the patient’s physiological needs and the level of involvement of other organs”, he states.

All of this, of course, has a high psychological component, according to dermatologist Bressan. Therefore, it is not as simple as saying “psoriasis is triggered by emotional factors”.

“We understand that it is not easy to make this change, this lifestyle habit. Every psoriasis patient knows that, when they are nervous, they can have a new crisis. It is also important to keep the skin manifestation under control, with hydration and the use of topical medications, so as not to develop into a severe form”, he points out.

Today, there are medications that can block the transition from the mild phase, which manifests mainly in the skin, to the severe phase. “We have access both in the SUS [Sistema Único de Saúde] as well as in the health plan network, medicines known as immunobiologicals, which are advanced therapies”, says Pinheiro. “And, of course, having a dermatologist, a rheumatologist, a nutritionist, a cardiologist, all the specialists treating that patient, is also fundamental.”

In Cianci’s case, his exams, consultations and medications are all carried out by a multidisciplinary team at SUS.

“Today I have a life like that of people without psoriasis, I do everything normally. I’m also lucky to be someone who shares information about psoriasis, not only through campaigns, but in my work. So, back then, that Luana who didn’t speak to no one, head down, clothes completely closed, who only saw the worsening of my skin, it no longer exists”, he adds.