Millions of People Have Psoriasis – and the Pandemic Has Made it Worse

This article originally appeared on VICE Italy.

“During the first lockdown, I noticed some scabs on my scalp,” said Mattia, 30. “I thought I had some sort of fungal infection, but was later told by a dermatologist I had psoriasis.”

Psoriasis is a chronic autoimmune disease that causes skin inflammation. If you have it, you’ll see thick, red, flaky patches on your scalp, elbows, knees, hands, nails and even your bum. In essence, your immune system is working at full speed, even though your body isn’t under attack, and producing more skin cells than needed. This makes your skin thicker and causes lesions and raised patches.

According to estimates by the World Health Organisation, about 100 million people across the globe live with psoriasis. Experts think the pandemic has made things worse for patients, as the condition is closely linked to stress, anxiety, depression and other mental health issues. A 2020 study based on an online survey found that 43.7 percent of respondents have experienced a worsening of symptoms since the start of the pandemic.

Dr Michele Cardone, a dermatologist at the Santagostino Medical Centre in Milan, attributed the uptick in cases to less sun exposure and increased stress, anxiety and depression. “The skin is an organ,” said Cardone. “It can be thought of as an extension of our minds.” Other pandemic-induced skin conditions are also on the rise, including contact dermatitis caused by hand sanitisers, and maskne, acne caused by face masks.

Like many other chronic diseases, psoriasis is multi-factorial, meaning it also affects other parts of the body. In about 30 percent of cases, it’s associated with arthritis and can cause painful swelling and stiff joints. It can also be connected with diabetes and hyperlipidemia (high amounts of fats in the blood).

The general causes of this skin condition aren’t clear – it’s a combination of genetics, environmental and psychological factors. Besides stress, alcohol, local trauma, burns or allergic reactions to drugs used for treatment can also trigger flare-ups.

Giovanni, 31, has been living with psoriasis since he was a teen. He says the first symptoms showed up after a period of high stress. “I was 15 and had a hard time relating to the outside world,” he said. “At some point, I started seeing spots on my hands and deep lines appeared on my nails soon after.” From there, the condition quickly spread to other parts of his body, becoming more or less severe depending on the period.

Diana, 31, has been dealing with psoriasis for about six years. “At first, I thought I was allergic to synthetic fabrics,” she said. “I had a severe itch behind my knees that spread to both legs.” She tried completely changing her wardrobe to natural fabrics. Her new clothes made her sweat less and improved her skin issues, but not significantly. Finally, she saw a dermatologist who gave her an official diagnosis.

Although there is no cure for psoriasis, treatment can make symptoms more manageable. In milder cases, doctors usually prescribe topical ointments and creams. If symptoms become more severe, doctors can resort to “modern biological drugs that regulate immune responses and reduce both inflammations in the system and in the skin”, explained Dr. Enzo Berardesca from the Dermatological Institute San Gallicano.

Chronic illnesses can come at a high price, at least in countries like Italy, where only the most severe cases of psoriasis are covered by health insurance. Buying other products suitable for sensitive skin are also a necessity, but can quickly add up in terms of cost. “You have to buy everything at the pharmacy and spend quadruple the normal amount of money on creams and detergents,” said Diana.

Unfortunately, since the condition gets worse when you’re in a frail psychological state, it can feed a vicious cycle. Lifestyle changes – including a restrictive diet and quitting smoking and drinking – are a fundamental part of the treatment for some psoriasis patients.

“The dermatologist advised me to avoid stimulants [like coffee, tea, cacao], spicy food, milk derivatives, alcohol and smoking,” said Mattia. But that’s easier said than done – Mattia has been struggling to quit smoking and drinking, especially because his work as a freelancer usually puts him under a lot of pressure to meet deadlines. “If I really wanted to solve the problem, I’d have to completely change my life,” Mattia said.

That’s why experts like Cardone believe treating patients’ mental health is just as important as addressing the symptoms visible on their skin. “I always recommend consulting a psychologist and creating a good doctor-patient relationship,” he said. Of course, the problem is that not everyone can afford therapy, or is able to tackle their stressors in other ways.

But for those who can, the payout can be massive. For instance, after years of battling acute flare-ups with aggressive drugs and cortisone-based creams, Giovanni has managed to get his symptoms under control. “The key was addressing the stressful situations that cause me anxiety,” he said. “Psoriasis was like an alarm bell for me, a sign that something in my life isn’t right.”

Correction: Due to an error during editing, this story did not initially mention Dr. Berardesca’s full credentials. It has now been updated to include them. We regret the error.