Singer Beyoncé revealed that she is living with a diagnosis of psoriasis, a chronic autoimmune disease that causes red patches and scaly plaques on the skin. The statement, which he recently made to Essence magazine, came as he reflected on the memories he has of his hair: “The relationship we have with our hair is a deeply personal journey. From my childhood in my mother's beauty salon to my father's use of oil. “I care for my scalp to treat my psoriasis, these moments are sacred to me.”
According to the Brazilian Society of Dermatology (SBD), psoriasis affects 1 to 3% of the world's population, which corresponds to approximately 125 million people. Of these, 5 million live in Brazil. In addition to Beyoncé, other celebrities such as Kelly Key, Kim Kardashian and Xand Avião also claimed to have been diagnosed with the pathology.
Psoriasis is not a serious disease and there is accessible treatment, including through the Unified Health System (SUS), that can control symptoms. However, apart from the fact that there is no cure, the pathology can also lead to emotional problems of selfesteem and social isolation, as it is an easily observable dermatological disease.
What is psoriasis and what causes it?
Abdo Salomão, doctor of dermatology at the University of São Paulo (USP) and member of the SBD, explains that the exact cause of psoriasis is unknown but is related to genetics and family history. In physiological terms, he explains that the emergence of the disease in the body is associated with an inflammatory process in one of the layers of the skin, the cells of which lose their adhesion and begin to peel off and flake off.
“As a result, the body creates more cells and carries out this process in such a way that the skin becomes thicker and scaly,” explains Salomão. For this reason, psoriasis is considered an autoimmune disease, meaning it is caused by the body's own defense system.
Scaly patches of damaged skin sometimes appear on the palms and feet, on the scalp, and even in the armpits, groin, and genitals (these cases, called inverted psoriasis, are less common). There are also cases where psoriasis affects the nails which is even rarer.
“As a rule, (the disease) spares the face because the sun has an antiinflammatory effect. Where the sun shines, psoriasis does not develop or psoriasis rarely occurs,” explains the specialist. According to Abdo Salomão, the disease occurs more often in adolescence or shortly thereafter and becomes milder with increasing age. “That doesn't mean there has been a cure, but the lesions and scaly plaques diminish (over time),” he says.
There are also risk factors that can lead to the manifestation of psoriasis or the development of symptoms, such as family history; stress (which can accelerate the onset of symptoms); Obesity; cold weather that contributes to dry skin; Consumption of alcohol, tobacco and also some medications antimalarials, those used to treat high blood pressure and also lithium.
“Alcoholism and alcoholism make psoriasis worse. And the emotional state with stress, worries, fears and insomnia also serves as a trigger for the disease to worsen,” says the doctor.
Symptoms of psoriasis
Although the severity of the disease varies in each patient, psoriasis generally causes red patches with dry, whitish scales on the skin; dry skin, itching, pain, burning and, in rarer cases, changes in the shape of the nail.
The symptoms of the disease are considered cyclical, meaning they appear more intense at one time and may be less unpleasant at another time. This may also depend on the emotional state of the patient. As Salomão said, the more anxious and stressed the person is, the more likely injuries are to occur.
In rarer cases, swelling and stiffness of the joints can also be observed, causing the socalled psoriatic arthritis, in which psoriasis affects the joint region. According to the Brazilian Society of Dermatology, up to 30% of patients suffer from this condition.
“Sometimes the patient shows symptoms in one place (of the body), sometimes they appear all over the place. “Plaque migration also often occurs because the change affects the entire skin,” says the dermatologist.
Symptoms of psoriasis
• Reddish patches with dry scales in places such as the scalp and elbows
• Dry, cracked skin spreads all over the body
• Itching, burning and pain
• Changes in nail shape and detachment
• Swelling and deformation of the joints
Treatments
There is no cure for psoriasis, but it can be treated and controlled, says Salomão. “The only thing we cannot promise the patient is that they will undergo treatment that will make the psoriasis go away and never come back. But we can promise that the treatments provide control. The disease disappears and no longer occurs during treatment,” he explains.
In cases considered mild, treatment involves moisturizing the skin with topical medications (creams) applied to the area of lesions. In some situations, exposure to sunlight (under the guidance of a dermatologist) also helps to improve the clinical picture.
Topical treatment with cream is generally sufficient. However, if the patient is resistant to this method, treatment with tablets in moderate cases or injection of immunobiological drugs in more extreme situations with numerous plaques on the body and also in the joints is necessary.
In the latter case, the drugs are very expensive, costing up to R$20,000. But according to Salomão, they can be purchased through the SUS.
There are also treatments that involve exposing the patient to ultraviolet A light (PUVA) or narrowband ultraviolet B light (NBUVB) in booths. In this method, called phototherapy, doctors use a combination of medications to increase the skin's sensitivity to light.
Mental health should also be treated, says the doctor
Because psoriasis is physically obvious and observable, it is also known for the emotional and social problems it causes in patients. People diagnosed with the disease experience changes in their bodies and difficulty with selfacceptance.
In addition, they also address the prejudices of those who believe the disease is contagious. Hiding wounds with clothing and isolating yourself becomes a common habit.
For this reason, dermatologist Paola Pomerantzeff, also a member of the Brazilian Society of Dermatology (SBD), warns that it is necessary to include the patient's mental health in the treatment. “Although it is a benign and noncontagious disease, psoriasis can have a significant impact on the patient's quality of life and selfesteem, affecting them physically, psychologically and socially,” says the doctor.
A 2020 study published in the medical journal JAMA Dermatology suggests that skin problems caused by psoriasis can increase a person's risk of developing mental illnesses such as depression and anxiety by 32%. And the deterioration of this emotional state, reminds Paola, is dangerous precisely because it is a factor that worsens the symptoms of psoriasis. In other words, it will snowball.
“A relatively new area of research in dermatology hypothesizes that if you had really bad psoriasis at a young age and were socially isolated, this could have an impact on your social life later, even if your skin improves,” comments the expert.
For them, the ideal is that psychological help is a protective shield so that the individual feels less the emotional impact of the illness. “It is necessary to show empathy and, with appropriate psychological support, give the patient space to talk about their skin condition and its impact on their life, which can help improve the response to treatment,” says the doctor.