The tremendous burden of psoriasis.

• Author: Menter, Alan
• Position: Medicine & Health

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WHAT DISEASE affects nearly 8,000,000 Americans, lasts a lifetime, and has no cure, causing not only physical distress. but often emotional and social difficulties, too? Chances are you did not guess psoriasis. The fact is, since most people are not generally exposed to psoriasis awareness campaigns or community advocacy efforts, there is an overwhelming lack of understanding as to what the disease is and why it warrants governmental research support and public attention. Psoriasis affects about 2.5% of the population and absorbs 56,000,000 lost hours of work each year.

Ironically, psoriasis is a hidden problem in part because it causes such visible effects. Psoriasis stamps its victims with bold patches of red, scaly skin that frequently are mistaken for an infection, so the sufferer cannot help but advertise his or her condition. Instead of generating sympathy from others, the red plaques draw sideways looks, rejection, silent judgments, and sometimes outright hostility. In fact, from Biblical times until as late as the 19th century, many psoriasis sufferers were banished as lepers.

One patient tells of a cashier who refused to take her money for fear of catching her disease---even after she explained that it was not contagious. Others relate stories of being turned down for dates and jobs by people who misunderstood the condition. Virtually everyone who has psoriasis has, at one time or another, suffered stares and questions. Patients give up wearing shorts or T-shirts, even on the hottest days of the year. I have known people to come up with creative approaches like "falling" into a swimming pool fully dressed so that they would not have to change into a bathing suit that reveals more skin.

A longtime patient of mine, Ty, tells a heartrending story of wearing shorts to a fast food restaurant, where customers stared, a woman pulled her child away, and the manager told him that if he used the drive-through instead of coming in to the restaurant, his meals would be free. He used this opportunity to buy $30 of food a day, then took it to his church. homeless shelters, and the local police station. Not long after, worn out with the daily humiliations, he dropped out of college. Though the story is dramatic, it is typical for those with psoriasis. No wonder so many patients work so hard to keep their problem literally "under wraps." Hiding and disguising psoriasis quickly becomes second nature for most. John Updike, in his short story, "'Day of the Leper,'" gives a vivid account of his life with psoriasis.

So, just what is psoriasis? Though it most obviously manifests as a skin inflammation, psoriasis actually is a result of an excessively vigilant immune system. Immune cells called T cells, which normally help protect the body from disease and infection, instead become overactive. They trigger other immune responses, including the release of proteins that induce a quicker rate of skin turnover. Blood vessels at the skin surface dilate, and more white blood cells arrive. While normal...