Psoriasis – A Public Health and Ethical Concern

Psoriasis – A Public Health and Ethical Concern

---

🔹 Introduction

• Psoriasis is a chronic, non-contagious autoimmune skin disorder.

• Characterised by red, scaly plaques and inflammation, commonly appearing on elbows, knees, scalp, lower back, etc.

• The condition affects 2–3% of the global population and 0.44–2.8% in India (Dogra & Yadav, 2010).

---

🔹 Causes and Pathophysiology

• Caused by an overactive immune system that speeds up skin cell growth.

• Genetic predisposition plays a role; however, triggers include:

  • Stress

  • Weather conditions (winter, monsoon)

  • COVID-19

  • Comorbidities (diabetes, hypertension, thyroid issues)

  • Obesity & metabolic syndrome

  • Environmental toxins (microplastics, endocrine disruptors)

---

🔹 Symptoms

• Red plaques, flaking skin, boils, itching, bleeding.

• Nail deformities, blisters, pustules.

• Variants include:

  • Chronic plaque psoriasis

  • Scalp psoriasis

  • Psoriatic arthritis

  • Erythrodermic psoriasis (severe form requiring hospitalization)

---

🔹 Social & Psychological Impact

• Leads to low self-esteem, anxiety, and depression.

• Affects quality of life and job prospects (as in the case of Mr. Krishnan).

• Often under-recognised by society and healthcare systems.

---

🔹 Treatment and Management

• Requires integrated and individualised treatment:

  • Topical treatments (creams, ointments, powders)

  • Phototherapy

  • Biological drugs (target specific immune pathways)

  • Lifestyle modifications

• Importance of managing comorbid conditions.

---

🔹 Trends & Public Health Observations

• Rise in cases, especially among younger populations.

• Psoriasis is increasingly seen as a systemic condition, not just dermatological.

• Links to mental health, cardiovascular risk, fatty liver, and metabolic syndrome.

---

🔹 Challenges in Management

• Lack of awareness among public and primary care doctors.

• Inadequate insurance coverage.

• Resistance to lifestyle change in chronic cases.

• Accessibility and affordability of biological drugs.

---

🔹 Ethical Issues (GS IV Link)

• Justice in healthcare: Limited access to advanced treatment for rural or poor patients.

• Empathy: Patients may face social stigma and mental trauma.

• Accountability: Systemic delays in diagnosis and treatment access.

• Autonomy: Need for informed consent and education about options.

---

🔹 Way Forward

• Launch national awareness campaigns on skin diseases.

• Include psoriasis in chronic disease care under Ayushman Bharat.

• Support mental health counselling as part of integrated care.

• Strengthen research on environmental triggers and genetic links.

• Training for primary care physicians on early identification and referral.

---

🔹 Conclusion

Psoriasis is a rising public health concern with deep physical, psychological, and ethical dimensions. An inclusive, research-driven and empathetic approach is vital to improve patient outcomes and uphold the constitutional promise of Right to Health.