Shrestha Tiwari suffers from a condition characterised by the presence of silvery scales on her body, which often turn red. Due to this, she has faced various stigma, ranging from misconceptions about it being contagious, or being linked to ringworm disease or blatantly asking her to cover her skin.
At 23 now, Shrestha advocates for normalising psoriasis. Psoriasis is an auto-immune skin condition that causes cells to build up rapidly on the skin's surface. This leads to the formation of red, itchy, and scaly patches, commonly called plaques.
For a deeper understanding of what Shrestha and many others living with psoriasis deal with, OnlyMyHealth got in touch with Dr Deepak Jakhar, Consultant Dermatologist – Dermosphere Clinic, New Delhi and author of the book ‘Good Skin Bad Skin’. His insights are under the ‘doctor speaks’ section in relevant parts of this article.
This is a story in our series ‘Survivor Stories’, where we hear from people who’ve combatted or are living with different diseases or ailments. We combine their life experiences with inputs from experts and doctors with relevant specialisations, ensuring that you get credible and authentic information.
Shrestha has been dealing with psoriasis for 16 years. It started with a wound on her toe that was not healing properly, leading to the development of scales on her feet. Over time, the condition progressed to affect her hands, eventually on her whole body. “After I think the 10-year mark, it was all over my body, and that is why it looks kind of severe,” she said.
Also Read: 5 Common Triggers of Psoriasis You Should Be Aware Of
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Doctor Speaks:
Psoriasis is a chronic autoimmune skin condition characterised by the rapid buildup of skin cells, leading to the formation of thick, red, and scaly patches on the skin's surface. It is a non-contagious condition that often goes through cycles of improvement and flare-ups. If someone has a family history of psoriasis, they may be at a higher risk of developing the condition. While not everyone with a genetic predisposition will develop psoriasis, having certain genetic factors can increase susceptibility. Besides genetics, environmental factors, such as infections, stress, certain medications, and lifestyle choices, can contribute to the onset and exacerbation of psoriasis in genetically predisposed individuals. For example, a skin injury or infection can trigger the appearance of psoriasis lesions in susceptible individuals.
Symptoms of Psoriasis
Psoriasis affects about one crore people in India, according to an AIIMS doctor, as stated in a report. The report also stated that the disease is on the rise in the country.
Scales, patches of red skin, and flaky skin are the most common symptoms of the condition.
Doctor speaks:
The symptoms of psoriasis can vary in severity and presentation, but common signs include thick, inflamed areas of skin often covered with silvery-white scales. The affected skin may be very dry, and in some cases, cracks or fissures may also develop. Psoriasis lesions can be itchy and may cause discomfort or pain in severe cases. In some individuals, psoriasis can also affect the joints, causing pain and stiffness (known as psoriatic arthritis). In addition, cardiovascular involvement and metabolic syndrome are also associated with psoriasis.
Also Read: How Psoriasis Can Affect Your Liver & Heart, As Per Our Skin Specialist
How to Manage Psoriasis
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While there is no permanent cure for this condition, she said there are several medicines and alternate remedies to manage it effectively.
Initially, Shrestha relied on steroid ointments for a while. However, after experiencing side effects, such as skin thinning, she decided to explore diet and lifestyle changes as alternatives to manage her psoriasis.
“I try to eat less processed food and stick to plant-based options that help manage the inflammation,” she explained. “I wouldn't say I've gone into remission, but keeping myself hydrated, a healthy diet, and adequate antioxidants have kept triggers to a minimum.”
Another method of managing the scales on the skin is by following an elaborate skincare regime. “I use cold pressed oils to moisturise instead of the steroid ointments, so I use coconut oil, olive oil or hemp seed oil,” highlighted Shrestha. “Keeping the skin moisturised is key, but many lotions available in the market contain alcohol, which is a skin irritant.”
Doctor Speaks:
There is no one-size-fits-all approach in treating psoriasis, as the effectiveness of treatment can vary from person to person. In addition, the choice of treatment option also depends on the severity of the disease and associated complications. The most common treatment options include:
1. Topical Treatments: Creams, ointments, and shampoos containing corticosteroids, vitamin D analogs, tacrolimus or coal tar can be applied directly to the affected skin. Topical treatment is generally recommended for localised infection. For widespread infections, topical treatment is supplemented with oral medications along with alternate therapies as well.
2. Phototherapy (Light Therapy): Exposing the skin to controlled amounts of natural or artificial Ultraviolet (UV) light under medical supervision is an effective way of treating psoriasis.
3. Systemic Medications: For moderate to severe cases, oral or injectable medications that affect the body's immune response may also be prescribed. A thorough checkup is necessary before prescribing these medications
4. Biologics: These are a new type of systemic medication that targets specific aspects of the immune system to reduce inflammation. Recently, research has suggested that biologicals can produce good outcomes in patients with psoriasis in terms of treatment and preventing recurrences.
5. Lifestyle Changes: Managing stress, maintaining a healthy diet, and avoiding triggers (such as certain medications, infections, or injuries to the skin) can help in controlling psoriasis.
The Journey To Loving Her Skin
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Growing up in a culture and society where products and advertisements glorify only one skin type, Shrestha struggled to love her skin in her teens.
“I was looking up to models and celebrities to have blemish-free, smooth, hair-less skin,” she recalled. “I've been interested in fashion and makeup and I think the definition of beauty for me became about looking flawless. Even my family had this notion, so you grow up to feel like okay, there's perhaps something wrong with you.”
For a period, it led her to cover up her skin where the patches would appear, like covering up her feet with socks, and full-sleeved sweaters for arms. Then came a surge of body positivity, especially through the content available online.
“The transformation started for me when there was a surge of demystifying beauty standards and stuff like that. People were appreciating body hair, talking about not needing to be skinny to be beautiful and other such things. So I felt okay, this is something happening naturally to me, so I don’t have to try to hide it,” said Shrestha.
She then started wearing clothes that did not hide my skin, from sleeveless tops and dresses to even bikinis. “Once I started doing that, I felt more confident and even posted pictures about it online. Then, I saw more and more people finding the inspiration to show their skin as well.”
Stigma
The stigma and judgement about Shrestha’s condition is multi-faceted.
“I think the stigma with people thinking that it's contagious or thinking that it looks ugly is just the surface of an iceberg,” she said. “I think the more hurtful thing is when people blame you for not taking it seriously enough.”
Apart from wondering if she’s getting treated properly, some people have also commented saying she’s doing this for social media fame.
“I've come across comments on my socials that say that please do not show this kind of stuff to people,” she added.
The dry skin, especially on the scalp and other parts of the upper body, falls off in flakes. It often looks like dandruff on some body parts. “People also assume that I’m unhygienic,” said Shrestha.
Getting used to having body hair too, took her a while. Due to the condition, she can never explore salon options like waxing and shaving.
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Can Psoriasis be Cured?
One of the most commonly googled questions around psoriasis is whether it can be cured or not.
Doctor Speaks:
Psoriasis is considered a chronic condition, and while there is no cure, various treatments can effectively manage the symptoms and improve the quality of life for individuals with psoriasis. Some people may experience periods of remission with minimal or no symptoms.
Finding a Community Through Social Media
Through her work on Instagram, Shrestha aims to reduce stigma and raise awareness about psoriasis. Multiple people reach out to her, telling her about how they’ve all found a sense of community through her page. Certain brands also collaborate with her to spread knowledge and normalise all skin conditions.
Even though many aspects of her life get affected by the condition, like jobs, dating and others, Shrestha strongly believes her approach and acceptance of her skin is what makes a world of difference.
Common Misconceptions about Psoriasis
The stigma is rooted in common misconceptions about the disease, from knowledge about how it spreads, to people assuming the extent of seriousness of it. We asked the dermatologist to clear the air around the most common misconceptions people have about psoriasis.
Doctor Speaks:
Common misconceptions around psoriasis include:
1. It's Contagious: Psoriasis is not contagious. It is an autoimmune condition that results from the immune system mistakenly attacking the healthy skin cells.
2. It's Just a Skin Problem: Psoriasis is not only a skin condition; it can also affect joints, leading to psoriatic arthritis.
3. It's Only a Cosmetic Issue: While psoriasis can affect the skin's appearance, it is more than a cosmetic concern. It can have a significant impact on an individual's physical and emotional well-being.
4. It's Easily Treated with Over-the-Counter Products: While some mild cases may respond to over-the-counter treatments, moderate to severe cases often require prescription medications and medical supervision.
5. It's Always the Same for Everyone: Psoriasis varies widely between individuals. Some may experience mild symptoms that respond well to topical treatments, while others may require more aggressive interventions.
Individuals with psoriasis should consult with a qualified dermatologist to develop a personalised treatment plan based on the severity of their condition and their overall health. Early intervention and consistent management can help control symptoms and improve the quality of life for those affected by psoriasis.