Psoriasis - more than skin deep
As a medical student, I got a grand total of about two weeks' teaching about dermatology, which covers not only all skin conditions but also the internal complications they can cause. The doctors I teach today tell me things have improved - but not by much. Almost half the doctors in the UK become GPs, and along with mental health issues, skin conditions are one of the most common problems they see. Even when they do see skin conditions in hospital, there is precious little teaching about the emotional distress they can cause. Small wonder it's a steep learning curve once doctors reach primary care.
Psoriasis is one of the most common, and most important, of the 'inflammatory skin diseases'. It affects about one in 50 people over a lifetime, which translates to a figure of about 40 affected patients on the average GP's list. By comparison to conditions such as eczema, for instance, which affect about one in six children before the age of seven years, this may seem unimpressive.
But while a few eczema sufferers are severely affected, many young people have only mild symptoms, and most grow out of it by their mid-teens. Because it's so common, people with eczema rarely get stared at in the street. Other people don't usher their children away from them when they see them in the swimming pool, 'in case they're catching'. That's exactly what happens to all too many people with psoriasis. It often starts in early adulthood, arguably the time when appearance and making a good impression are most important. The scaly skin plaques can be sore and painful as well as unsightly, and it can affect nails and joints as well. It's hard for people to predict when they will have a flare-up - in fact, stress may play a part in flare-ups, so worrying about their skin being bad before an important engagement can actually be a self-fulfilling prophecy. The psychological toll of a chronic, incurable skin condition like psoriasis can be very heavy indeed.
The 10th World Psoriasis Day, marked on 29th October, aims to raise awareness and understanding about the condition. This year the campaign focussed particularly on people who don't have access to the many treatments available to British sufferers on the NHS. But even with the best treatment, psoriasis can still be a tough condition to live with. It's bad enough to suffer from itchy, painful, scaly skin without other people making it worse by insensitive remarks. One of my patients told me recently that a colleague had complained when she went to hospital for light treatment. Their comment? 'It's only your skin and it's hardly as if it's going to kill you.' So my patient not only suffers daily, she should now feel guilty too. Can we ignore World Psoriasis Day because British patients can get specialist treatment on the NHS? Not while this attitude is still out there.