Battle against psoriasis is more than skin deep

Rose Jebiwott Boit, psoriasis ambassador and former Kenyan High Commissioner to Namibia. [PHOTO: WILBERFORCE OKWIRI/STANDARD]

NAIROBI: “It began as an itch on the right side of the scalp, progressed to the head and later the entire body, as my stress levels increased,” says Rose Jebiwott Boit, a former Kenyan High Commissioner to Namibia.

As the skin condition spread to the neck, chest and eventually the entire body, she sought medical attention once she returned to Kenya at the end of her ambassadorial posting.

“In June 2011, I was admitted to hospital for a week from what doctors termed as complications of psoriasis,” Rose says in an interview with The Standard on Saturday.

This marked the beginning of her journey to understand psoriasis, its treatment and management, four years ago. The condition, which she attributes to work pressure, also plunged her into a career she had never dream of; creating awareness on skin conditions as a psoriasis ambassador.

“I was confused but gradually understood that stress was the causative factor of this flare up,” she says.

Psoriasis was recognised as a serious non-communicable disease by the World Health Organisation at the 67th World Health General Assembly.

LIFESTYLE DISCIPLINE

It is a life-long skin disorder that causes dark, or red, scaly patches called lesions to appear on the skin and affect both sexes equally. It can occur at any age.

“Psoriasis is found in three out of every 1,100 persons globally and also has a genetic link,” says skin specialist Evanson Kamuri.

In January, last year, former CNN news anchor Zain Verjee went public about her battle with psoriasis, citing tough lifestyle discipline as one of the effective ways of managing the condition.

This includes a special diet, a strict exercise regime, a strong social support network and meditation.

“My scalp spits out silver flakes. My ears are filled with crusts. I leave white specks wherever I sit. I float in long, loose clothes. My hands betray me. The sores sit openly. My nails are dented with pockmarks. I find strands of hair on the sheets and pillowcases every morning,” reads part of Verjee’s article, which explained that she had suffered from psoriasis since she was eight years old.

Dr Kamuri says the cause of psoriasis is unknown though researchers agree that the immune system in people affected by psoriasis is mistakenly triggered, which speeds up growth cycle of skin cells.

It begins in the immune system, mainly with a type of white blood cell called a T cell. T cells help protect the body against infection and disease.

In some people, the first flare of psoriasis happens during a particularly stressful time and the source of pressure can either be external or internal.

“Stress can trigger onset of psoriasis. Thereafter, the skin condition can affect socialisation, for example when shaking hands, swimming or dating. The key issue is to manage stress levels, whether you have been diagnosed or not,” says Dr Kamuri.

He points out that the ragged appearance of the skin condition affects the self-esteem of patients who fear, and sometimes experience, rejection.

Other complications of psoriasis include type two diabetes, high blood pressure, some heart diseases, Parkinson’s and kidney disease and emotional effects such as low self-esteem, social isolation and depression.

The WHO recognises that persons with psoriasis have relatively higher risks of heart disease, stroke, hypertension and diabetes.

“It makes the skin seem ugly, thus affecting our confidence, but we are not our skin and we hold our heads high,” says Rose, while pointing out that arthritis of the fingers has disfigured one of her nails.

Rose identifies stress at her work station as the trigger for the onset of her psoriasis and has in turn begun advocacy under Tulivu (Swahili for ‘tranquil’) Stress Management Consultancy.

She hopes to create awareness on effective stress control by enabling people identify sources of stress in their everyday life.

Other common sources of stress include domestic pressures like an overbearing spouse, siblings or children, major life events such as the death of a loved one, separation, imprisonment, financial strain or prolonged illness, and political threats.

WHOLESOME APPROACH

Rose cautions individuals to look out for signs such as unclear pains and aches, indigestion, mood swings, withdrawal from socialisation, increased irritability and change in sleep patterns, including difficulty falling asleep and waking up tired.

“Internal causes of stress include lifestyle choices such as strict work schedules that enhance overload, lack of sleep, self-criticism and perfectionist tendencies,” Rose says.

A research paper by Charlotta Remröd and colleagues published in May this year identified between 37 and 71 per cent of patients reported psychological distress as one of the major causative agents for onset, exacerbation and maintenance of their psoriasis.

“Nearly 50 per cent of patients in our study experienced that onset of their psoriasis was related to a particular stressful period or situation in life,” read excerpts of the paper that called for a wholesome approach to the skin condition.

According to the scientist, the respondents got tired frequently, could not handle being interrupted when working with something, had difficulties concentrating on their work if the environment was distracting, easily felt pressured when told to speed up work or feel insecure when facing new tasks.

“Stress management does not mean the mere removal of stressors, but the capacity to enable the human personality absorb a higher degree of stress,” Rose adds.

She concludes: “Stress is part of human life and cannot be avoided entirely. However the most important thing is to manage the stressors.”