Features

Check Up: Dr. Abdul Ghani Kibbi discusses psoriasis

Fall 2020/Winter 2021

Q. What causes psoriasis? Is it stress-related? Hereditary? Does it occur more among a certain demographic?

A. We didn’t know the cause until recently. But over the past two decades, a lot of research has led us to conclude that it’s an autoimmune condition. There’s certainly a genetic aspect. Its inheritance mode is polymodal, so there are several genes involved. Certain triggering factors such as stress and infection are required for psoriasis to manifest on the skin. When it does, psoriasis can take a variety of clinical manifestations, one is guttae psoriasis—which is small and teardrop-shaped. This type of psoriasis is usually precipitated by an infection.

In its classical form, psoriasis occurs in larger batches and is distributed over the scalp, hands, feet, or genitalia. It usually affects the scalp. It can spread over a large area and areas can adjoin to form something that looks like a map in an atlas. This type of psoriasis can be triggered by all sorts of stress, like the death of a close friend or family member, or like being in a warzone. Many psychological states, like anxiety and depression, can trigger it. Psoriasis by itself can cause depression or anxiety, especially when its widespread, because of the effect it has on one’s appearance. For example, I treated a banker who had an itchy scalp and very bad dandruff. He was embarrassed at business meetings when large thick flakes would appear on the shoulders and the lapels of his jacket. He was afraid that people might think that he hadn’t showered or didn’t have good hygiene. The effects of psoriasis are bidirectional in that the condition can be caused by or can cause anxiety and depression. Still, not everyone who has psoriasis can point to a stressful situation.

Q. Can it be prevented?

A. If you have the genetic makeup for it, you cannot prevent it. But you can try and identify the triggering factors that will exacerbate the condition. Of course, there’s no cure. I tell my patients, regardless of how bad it is—and bad depends on the affected surface area—I tell them it’s a lifelong disease. If you don’t adhere to the treatment, then your psoriasis is not going to be under your control. It’s a chronic condition. I try to help them make peace with that fact. It’s not a skin-limited condition. There is evidence now from various research studies that it has other co-morbidities which can be seen in patients with moderate to severe psoriasis. Such patients may have associated co-morbidities such as risk of cardiovascular disease and metabolic syndrome.

Q. How common is it? How many psoriasis patients do you see in a month, roughly?

A. I tell people that the bread and butter of dermatology is acne, psoriasis, and eczema. Among ethnic groups, prevalence can range from 1 to 11 percent, Scandinavia being on the higher end. In Lebanon, although we don’t have a database, my estimate is that about four to five percent of the population in Lebanon may have psoriasis. I see in the range of 10 to 15 new psoriasis cases per month. I get referrals from other dermatologists for cases ranging from mild to severe. Most cases, I’d say 60 to 70 percent, are mild.

Q. Can a person self-diagnose and treat the condition? How?

A. Well, of course, public awareness has grown so much that I often get patients who are aware that they have psoriasis when they come in. They Google or do research. We exert a lot of effort to increase public awareness. The WHO made a resolution in 2016 to recognize that psoriasis negatively impacts quality of life. The WHO underscores public awareness. You don’t just treat the psoriasis, you treat the co-morbidities, the stress. October 29 is world psoriasis day. Across the globe, organizations are sponsoring public health initiatives to educate the public about psoriasis and how it affects sufferers.

Q. And how do you treat the condition?

A. First, I define what type of psoriasis I’m dealing with. Then I go over quality of life issues, the psychosocial component. I take all of this into account before I decide on the treatment. Mild cases are treated with topical cortisone. For moderate to severe psoriasis, topical creams aren’t practical because of the surface area involved. For moderate to severe cases, we use a special type of cabinet, like what is used for tanning; it’s calibrated with UV light and takes about six to eight weeks to have an effect. Or we use an anti-cancer drug, methotrexate, given as an oral tablet weekly, which also takes six to eight weeks to act. Over the last ten years or so, we have come up with a more powerful class of treatments called biologics. These are immune modulators that work effectively with psoriasis. Many dermatological societies advocate for these as a first line of treatment.