Why psoriasis takes a heavier toll on women

Social rejection, pressure to look good make it harder for women to cope

psoriasis-women

Soniya Handa's world has literally turned upside down. The 30-year-old from Haryana suffers from psoriasis, a chronic skin condition that causes scaly patches of skin to appear. Handa hardly gets any support from her family when her symptoms worsen. ''Her husband and mother-in-law send her back home whenever she has a flare-up. Her brother gets her treated and then sends her back to her marital home,'' says Dr Monica Bambroo, head of department, dermatology and cosmetology, Artemis Hospital, Gurgaon, who treats Handa.

Psoriasis is an autoimmune disease. ''It is a common skin condition that causes thick, red, silvery or scaly patches on elbows, knees and lower back. Scalp, nails, palms and soles can also be affected,” explains Dr Shivani Bansal, associate consultant, dermatology, Max Multi-Speciality Hospital, New Delhi. Psoriasis comes from the Greek word 'psor' which means deep effervescence. It is a chronic inflammatory skin disorder, which is not contagious.

Psoriasis is more prevalent in men. However, in the last five to six years, the incidence of psoriasis among women in India has increased by 20-25 per cent, says Dr Deepali Bhardwaj, a leading dermatologist and allergy specialist based in Delhi. “This could be due to the increasing incidence of smoking in women, more stress and exposure to chemicals,” she adds.

Female patients with psoriasis experience more severe symptoms, compared to men. They also struggle more with the emotional and psychological impacts of the disease. Women are more under pressure to look good in our society than men and hence they are especially disturbed by the cosmetic appearance of patches. ''Their stress sometimes results from anticipating others' reaction to the disease which contributes more to the psychological stress and severity of psoriasis,'' says Dr Khagendra Varda.

That women undergo many physiological changes in their lifetime makes treatment of psoriasis more challenging. ''In most cases, it improves with pregnancy especially in the first and second trimester. However in 20-30 per cent patients, there can be a flare with pregnancy. This is unpredictable. It could be a life threatening variant like pustular psoriasis or erythrodermic variety also, which needs urgent medical care,'' says Mumbai-based Dr Deepti Ghia, consultant dermatologist and dermo surgeon at Jaslok Hospital and Research Centre on psoriasis in women. ''Most oral medications are contraindicated with pregnancy, hence it is important for patients to plan their pregnancy to avoid complications,'' adds Ghia. Methotrexate, which is considered to be the best drug of choice is not recommended for child bearing age and during pregnancy and lactation. This could result in psoriasis progressing and spreading over the whole body. ''Also during childbirth, the c-section incision can be a site of Koebner's phenomenon and there may be psoriasis appearing at the site of scar. Patients with psoriatic arthritis need special attention as most medications which help to alleviate pain are contraindicated, and they may need bed rest in pregnancy and special considerations for delivery,'' says Ghia.

Ankita Kapoor from Kolkata suffered recurrent rejections from prospective grooms because of her psoriasis. “It made me really anxious, which aggravated the disease further,” recalls the 27-year-old.

Finally she got married to a Navy officer. While going on ship, she was put on strong medicines as creams did not control the disease. One of her drugs required her to get a liver function test done to see whether the medicine was working or not. Scared of the stigma, she did not get the test done. ''By the time she came back, her liver had got damaged,'' says Dr Sujit Shanshanwal, consultant dermatologist, Apollo Clinic, Mumbai.

The disease also affects one's self esteem. Patients sometimes slip into depression and consider themselves incompetent. Priyanka Rengaswamy, 34, who worked as a team leader in a software company was shattered when she was diagnosed with psoriasis. When she went for a consultation with Varda, she insisted a fake name be used on hospital records as she did not want to reveal her identity. Her body was covered with plaques and both the patient and her mother were in tears, recalls Varda. ''I prescribed her a drug imported from the US. It cost her Rs 1.5 lakhs. But within three months, she was able to get rid of her plaques,'' he says.

Psoriasis could take a toll on a woman's love life, too, as she becomes uncomfortable with her body. ''These patients often do not feel good about themselves. They feel guilty. They do not feel they are beautiful. Many a time the spouse also feels the same. Their life may be totally affected by this. They may have a totally loveless life. They just go on with their lives without any emotional or physical contact between them,'' says Bambroo. She adds that most of the time people are not aware that there are effective treatments for psoriasis which can help improve their quality of life.

Elderly women with psoriasis often say that they are not allowed near their grandchildren. They suffer discrimination in their own homes though the disease is not contagious.

There are several reasons why psoriasis strikes women harder. Many of them prefer using home remedies and over the counter medicines and choose not to be treated. By the time, they seek treatment, the disease will have increased many folds. The course of psoriasis in women can be affected by hormonal factors during puberty, pregnancy, and menopause, says Bansal. Many women find psoriasis improves during pregnancy but flares after birth. ''Although there is no cure for psoriasis yet, treatment can ease symptoms. If you have psoriasis, see your dermatologist as often as recommended. They can help you find a treatment plan that works for you,'' she adds.

Moreover, it is essential for these women to get emotional support, says Bambroo. Having a supportive family to fall back on can be a great source of strength and positivity for the patient.

(Some names have been changed)

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