For South Africans living with psoriasis, every day is a physical, emotional, and mental battle.1 They face this battle every time they look in the mirror and see red patchy skin, with a white scaly layer on their faces, elbows, knees, lower back, and scalp.1,2 Or when they struggle to hold a cup, or brush their teeth because the joints in their hands are stiff and are in excruciating pain.1,2 Even a fun summer's day out can be uncomfortable, as they have to cover up and hide the red patches to avoid judgemental stares and intrusive questions.1,2 

Psoriasis and comorbidities1,2,3
Psoriasis is one of the most common skin diseases in South Africa. One study in KwaZulu-Natal identified psoriasis in 12 out of 785 people. It's also a chronic condition that is more than skin deep.

"Psoriasis is a genetic condition, not caused by infection, and not contagious. It's an immune mediated condition, and while symptoms are visible on the skin, the disease can affect the whole body and can be dangerous if untreated,” said Dr Ugeshnie Naidoo, a Gauteng-based dermatologist.

Some of the conditions that can occur in addition to symptoms on the skin are heart disease, diabetes mellitus, high cholesterol, obesity, hypertension, anxiety, stress, and depression.

Diagnosing and treating psoriasis2,3
Dermatologists are best suited to make a diagnosis and recommend the best course of treatment. For South Africans who aren't on medical aid and don't have the financial means, treatment may not be possible.

Millions of South Africans rely on public health, and a general practitioner or nurse is their first point of medical contact.

The same study indicates that the public healthcare system is over-burdened, difficult to access for patients, limited resources are available, and patient referral to specialist care could be difficult due to the low number of dermatologists in the public sector, for example there are only five practicing public health dermatologists in KwaZulu-Natal.

This lack of resources puts tremendous strain on public health and makes it more difficult for people who need it the most to get the right medical help.

What treatment is available?
Psoriasis is a lifelong condition, and although there is no cure, dermatologists can help treat the condition and recommend treatment is started as early as possible.

“We can change the course of the disease. The sooner we treat it, the more effectively the outcome, and we can prevent all the long-term problems associated with psoriasis,” added Dr Naidoo.

Psoriasis treatment depends on the severity and may include,2

• Creams
• Light therapy
• Antibiotics
• Oral medications
• Biologics.

Effective treatment can achieve clear skin2,3
Accessing the right psoriasis treatment is crucial. If you're on medical aid, ask your doctors to help you access effective treatment that will relieve your psoriasis symptoms and help you achieve clear skin. In the public health sector, activists are recommending additional training to enable doctors and nurses to treat skin conditions, as well as educating people living with psoriasis about the importance of early treatment.

The same study mentioned earlier shows that in KwaZulu-Natal, nurses are eager to learn more, and since the study was published, there's been an increase in qualified dermatologists, which will reduce the waiting time for people who need help. Although this is only the beginning, it offers hope that more people will have access to the medical care they need, regardless of their medical aid status.

One patient, Melanie*, visited her dermatologist and started a biologic treatment that changed her life.

"It was very embarrassing to live with psoriasis, especially with it all over my face and head," said Melanie. "I'm on a biologic treatment, and it works like a miracle. I have 99% clear skin."

There is no cure for psoriasis, but with the right treatment, you can manage the condition, and you can live a normal and fulfilled life, free of physical and psychological pain. "The biologic treatment has cleared up most of my symptoms and I'm living a normal life for the first time in decades," said Melanie.

If you or a loved one shows any symptoms of psoriasis, itchy, flaky, or red patches on the skin, seek medical help from a dermatologistas soon as possible. You can also learn about this condition and visit the online community #MoreThanSkinDeep on Facebook. People living with psoriasis deserve the right treatment and the chance to live and thrive with clear skin. 

*Patient’s name has been changed to protect their privacy.

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References

1. Mayo Clinic. Psoriasis. https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840. Accessed on 18 October 2021.
2. Psoriasis Association. Types & Treatments. https://psoriasis.org.za/types-treatments/. Accessed on 18 October 2021.
3. Aboobaker, J.B. Skin Disorders In Primary Health Care In KwaZulu-Natal: Testing For Solutions After Assessment Of Burden Of Disease, And Evaluation Of Resources. https://researchspace.ukzn.ac.za/xmlui/bitstream/handle/10413/7823/Aboobaker_Jamila_B_2012.pdf?. Accessed on 18 October 2021.