When the skin expresses the discomfort of the mind: what is it and how to prevent psoriasis

Circular baldness on the scalp, scaly spots that are gaining ground on the skin, irritation, burning and the very discomfort that is supposed to be suddenly invaded by these patches that attract everyone’s attention. Here are some effects of psoriasis, an increasingly common but still little known condition. And it doesn’t just affect the skin, as one might think, but has much deeper causes and consequences.

Have you ever heard the term “somatize”. It turns out that Juanita is going through a bad time, very stressful, and although the cause is not known, the effect has become visible and not just in the state of mind. Also on his skin, full of wounds that appeared overnight. What happened? Juanita somatizes — or physically manifests psychological discomfort — a situation that generates high stress for her. And in his case, he does it through psoriasis.

Psoriasis is a condition of the immune system, in which skin cells begin to accumulate, forming dry patches, scaling and causing a constant state of itching and discomfort in the affected person.

Not everyone is at risk for psoriasis – it’s genetic – but it’s also not possible to rule out whether or not someone is in the risk group. Grandparents and siblings are usually a common background.

“It can be triggered at any stage of life, as a child, as a young person, as an adult or in old age. It is more common before the age of 40, but it can also appear for the first time at an advanced age,” says Tatiana Riveros, dermatologist at the German Clinic.

Psoriasis is also inflammatory. As Riveros explains, “the person generates antibodies, defenses, white blood cells that make the skin sick.” And just like the skin, so does the whole body, making it a multisystem condition. “It is important to understand that this is a condition associated with many related diseases,” says Claudia Moreno, dermatologist at Clínica Indisa.

Cardiovascular diseases, diabetes, hypertension and metabolic disorders appear as potential causes and consequences of psoriasis. This is the importance of serving him on time. Failure to do so implies the possibility of generating a massive release of cytokines at the blood level, which according to Moreno “can manifest negatively in different organs, mainly in the heart”.

On the other hand, not being treated in time involves the risk of progression of psoriasis and production of what is called psoriatic erythroderma. This, explains Natacha Quezada, a dermatologist at the UC Christus clinic, corresponds to “a large burn all over the body”, which requires hospitalization.

Psoriasis is a multifactorial disease that can be triggered by various reasons, such as infections, a simple cold or obesity. But perhaps one of the most common triggers has to do with mental health, specifically stress. This is why it is a psychosomatic illness: the physical disorder is associated with psychological discomfort.

“Psychic factors can promote the appearance, maintenance and remission of crises”, explains Cinthia Cassan, psychiatrist and psychoanalyst, co-editor of the book. “Rethinking the psychosomatic, from the clinical to the psychosocial” , published by Sonepsyn Editions. “In other words, emotional stress can cause injuries to resurge.”

Stress is usually related only to work strain, but it can have many roots for different people. “Emotional situations, related to changes, moving or separation from loved ones, are those that most frequently influence lapsoriasis or its attacks.”

Cassan argues that the symptoms of psoriasis, particularly dermatological ones, can be seen as the “tip of the iceberg”: an indicator that “something is going on emotionally that the subject has not been able to process , to put into words or symbolize. For this reason, it touches directly on the real of the body”. There, it seems to “show” that something is “wrong” and asks to be interpreted, first to be understood, then to be able to modify it.

Just as mental health can trigger psoriasis, it can also make it worse. Any dermatological lesion, such as psoriasis, can cause worry, emotional discomfort, insecurity and social withdrawal. In some, the psychiatrist points out, this can even cause cases of depression and anxiety.

“Being a skin disease, there is a significant emotional issue which can be a cause or a consequence. A vicious circle is generated which can be perpetuated by psychological condition states, which in turn makes treatment more complex” , adds Claudia Moreno.

According to Cassan, and based on the experience of psychoanalysis, the people most at risk of developing psoriasis are people “having difficulty becoming aware of their emotions and putting them into words”, in addition to have a genetic background.

Psoriasis has different variants. The most common is called “vulgar psoriasis”, also known as plaque psoriasis, which occurs in a range of 80 to 90% of cases . It usually manifests as red, scaly patches on the elbows, knees, scalp, lower back, and abdomen. Most of these cases are mild and can be treated relatively easily. However, in some people, the disease can be severe and even fatal.

Other types of psoriasis, such as the reverse, can affect crease areas, such as the armpits, buttocks, or breasts, as well as the face and compromise the nails.

But to these complications is added the social effect of psoriasis, which can have a great impact on the individual, because the lesions are striking”, specifies Natacha Quezada. Discrimination or incisive gazes are part of a normal environment in patients and this, in addition, can mean greater stress and the possibility of a recurrence of the disease.

Faced with the unfavorable climate faced by those who suffer from psoriasis, Quezada calls for “educating the population about this disease which is not contagious and which has millions of patients worldwide, so that those affected are not discriminated against”. . Currently, the figure is between 1 and 4% of the world’s population, a number that “clearly” is growing as we live “in an increasingly stressful environment”.

And when it comes to stressors, the covid-19 pandemic cannot be ignored. A survey carried out in 30 countries during the year 2021 established that more than half of the participants from Chile, Brazil, Peru and Canada assured that their mental health had deteriorated since the start of the pandemic. In Chile, according to Mental Health Thermometer 2021 approximately 33% of respondents reported having symptoms associated with mental health.

With the pandemic, the disease had “an explosion and affected people who have a genetic background but lack control over stress, the environment and their quality of life”, explains Natacha Quezada. A study published in the United States He added another piece of information: one of the effects of covid-19 in critically ill patients has been inflammation of the respiratory system due to a “storm of pro-inflammatory cytokines”. The same agent that acts in psoriasis.

So not only have there been more cases of psoriasis worldwide, but severe cases have also increased and become more complex.

Most cases of psoriasis correspond to the common type and have mild effects. However, the specialists call that in the presence of symptoms it is essential to consult as soon as possible, both a dermatologist and a therapist specialized in psychosomatics, so that they can carry out the corresponding evaluations.

Although the above seems obvious, Cinthia Cassan says that one of the main difficulties in treatment is late consultation. “The more advanced the disease, the more difficult or slow the remissions.”

Treatments are generally quite effective in controlling symptoms, although it is essential that the skin and mental dimensions are covered. The first is the use of topical anti-inflammatory corticosteroid creams, which may include urea derivatives, salicylic acid and tar. When the condition covers more than 10% of the person’s body, treatment becomes “systemic” with biological drugs that seek to speed up the process of skin cell reproduction.

In addition to medication, “skin care is important,” says Claudia Moreno. For this, he recommends using gentle products for the bathroom: a substitute for soap or Syndet, and a moisturizing and lubricating cream to maintain the good skin barrier.

Natacha Quezada adds that it is essential to apply cream every day, morning and evening, to keep the skin hydrated. Otherwise, dryness can be a trigger for the disease. And be very careful with sun exposure.

Nor is it necessary to take medication to prevent the onset of psoriasis on the scalp, a common area of ​​affliction and which is usually left with true bald spots. For this, the daily use of anti-dandruff shampoos is enough. “We must not let dandruff win the process and become psoriasis,” says Quezada.

Rubbing clothes against the skin, as well as scratching a lot, can increase psoriasis. This is due to Koebner’s phenomenon, which is the appearance of new lesions in places with some type of trauma or pressure, even when the skin is “healthy”.

Claudia Moreno advises not to forget the metabolic dimension of psoriasis, and therefore to favor an adequate lifestyle: take care of food, sleep and physical activity. Although changing habits can be difficult for patients, the better they can adapt to them, the better their prevention results will be.

Having an enjoyable activity or hobby, says Cinthia Cassan, such as listening to music, playing board games, reading or going for a walk in nature also helps maintain good mental health. In addition to practicing meditation, yoga or relaxation techniques.

“Psychotherapy can be very beneficial: speaking freely with another neutral person, and with whom a bond of trust is established, promotes knowledge of one’s own emotions and their expression in words, which makes it possible to change points of view, to perform inmate duels, to encourage compassion. and self-acceptance,” says Cassan.

Likewise, maintaining meetings with loved ones, friends or family, avoiding social isolation and setting limits so as not to overload yourself at work will help to keep stress away and, incidentally, psoriasis.