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At a psoriasis center launch, specialists reveal disease's hidden symptoms, risks
Rizal Medical Center on Tuesday, April 17, launched a specialty center for psoriasis that will offer a full spectrum of diagnostics and treatments for patients, including an unspecified "biologic drug" that the hospital has the exemption use as medication for severe cases.
Living with psoriasis
Psoriasis Philippines president Josef de Guzman describes the disease as "severe, chronic, non-communicable, disfiguring, and disabling" and, as it is surrounded by myths and stigma, is detrimental to a patient's social well-being.
At the launch, De Guzman along with psoriasis patients Josie Reyes and Llynerd Bernardo detailed the impact of the disease beyond their skin. All three lost their jobs upon diagnosis.
For Josie, who was a sales agent for a mall, the pain psoriatic arthritis prevented her from performing her tasks. "Hindi na po ako ngayon nakakapagtrabaho. Na-miss ko po ang customer service ng mall, kasi po 'yong company namin, since hindi na po ako makalad, hindi na po ako matanggap."
Llynerd shared the same story, losing out on a career because of psoriasis. Despite graduating with a degree in marine transportation, psoriatic arthritis also prevented him from pursuing work and even stopped him from playing sports.
Josie was diagnosed with psoriasis in September 2016, after initially dismissing the symptoms as post-natal pains. "Hindi po ako makalad. Bale po 'yong paa ko hanggang tuhod ko, 'yong kamay ko po hanggang siko ko hirap gumalaw," she said.
Josie added that she couldn't even hold her baby because of the pain.
Meanwhile, Llynerd's first symptoms were on his nails. "Napansin ko lang po na may parang nana...hindi ko po masyadong iniisip, pero hanggang [lumala] po. Unti-unting nadagdagan po."
Read: Psoriasis affects patients more than skin deep
Hidden symptoms
Dr. Rogelio Balagat, Rizal Medical Center's head of Dermatology and Rheumatology detailed that the first symptoms include a rash and pain in the heels that won't go away.
What people perceive as the usual manifestation of psoriasis are scaling on the skin, mostly on visible areas like the limbs. However, Balagat and Dr. Mae Ramirez-Quizon explained that psoriasis affects the skin and this includes are hair and nails.
"The red rash or plaque...you can have it on the scalp, you can have it on the nail — you can have it anywhere," Ramirez-Quizon said. The face is usually spared, but in severe cases, it also manifests on there.
The "rash" thickens the skin, adding a slight silver sheen to it. "That's the classic [symptom]. There are those that are difficult to treat, which is why we're emphasizing the importance correct diagnosis when you want an effective treatment," Ramirez-Quizon explained.
Ramirez-Quizon, a hair and nail specialist, she pointed out that, like in Llynerd's case, psoriasis can simply manifest "as a simple nail finding."
"It could be just a separation of the whitish of the nail ... or parang bakubako — crumbly nails," she said. Some of these signs are mistaken for a fungal infection, which leads to patients coming in too late.
"If you see a nail lesion that looks abnormal, go to a dermatologist," Ramirez-Quizon said. She additionally encouraged people who have persistent dandruff and scaling on their scalp to go to their dermatologist for diagnosis and treatment. "Sometimes [dandruff] is just the beginning of psoriasis."
In an interview with GMA News Online, Ramirez-Quizon said that dandruff could just be dandruff but it's better to be safe and get treatment as soon as possible because psoriasis, if left untreated, could worsen and cause complications.
For example, Ramirez-Quizon said that white spots on the nails could be the first sign of the disease and it could progress to the joints — disfiguring the fingers and making treatment more complicated.
Psoriasis is a multisystem disease as it associated with other serious health conditions such as diabetes, heart diseases, and depression.
The last one may be owed to the denial of educational or work opportunities to patients suffering from psoriasis, as well as the withdrawal from social interactions due to stigma (whether internal or external).
Diagnostics and treatment
Dr. Charlene Mari Ang-Tiu, head of dermtologic surgery and procedural dermatology, told GMA News Online that underreporting and misdiagnosis make it hard to estimate the number of patients suffering from psoriasis in the Philippines.
The current statistics available is 1 to 2 percent of the population, but this number inaccurate.
As they launch the Psoriasis Center, the staff of the Department of Dermatology at Rizal Medical Center hope that more people come forward and seek treatment.
"Rizal Medical Center is blessed to have all the staff that [it has right now, headed by] Dr. Rogelio Balagat. [He] is the only internist at the same time rheumatologist and a dermatologist. So the whole spectrum of medical care, nasa specialty niya," Department of Dermatology Chair Francisco Rivera told the press.
"We not only treat the patient, we [are also] able to provide the full spectrum of management: oral meds, topical meds, phototherapy, and the injectables. We are the first [Department of Health] institution to be allowed to use this injectable," Rivera added.
The drug is currently not included in the Philippine National Drug Formulary (PNDF), but it is accessible to people who can afford it. Poor patients cannot avail of the injectable biologic drug because of the policy against prescribing medication not listed in the PNDF.
Rivera told the press that Rizal Medical Center pushed for the exemption to democratize this biologic drug. "What we did was to apply for an exemption and we are blessed to be granted — to be the first to be granted this exemption. Here at Rizal Medical Center, we were able to complete the line of treatment [for patients with psoriasis," he said.
Balagat is joined by other leading specialists like Dr. Alma Gay Concepcion Tavanlar-Amado and Dr. Mae Ramirez-Quizon who are "equipped with a broad range of treatment modalities for psoriasis" including photodermatology, support groups, and counseling.
Being a chronic and incurable disease, psoriasis is burdensome financially and Rivera said that it is their goal to help connect patients to existing government projects that offer assistance to patients who cannot afford treatment. — LA, GMA News
