October 29 is World Psoriasis Day. In our country, this is the only skin disease declared to be socially significant, but despite this, little is said about it, and the problems of patients with psoriasis and the doctors who have to treat them, it turns out, are not at all small. The negative impact of the disease on the patients' quality of life is comparable to that of severe chronic diseases, such as diabetes, depression, myocardial infarction, some oncological diseases. How psoriasis manifests itself, is it contagious and what are the modern methods of its treatment, these questions are answered by the head of the Department of Dermatology at the Military Medical Academy, Dr. Vesel Kantarjiev.
He graduated from the Medical University in Sofia in 2004. In 2013, he acquired the speci alty "Dermatology and Venereology", and since 2018 he is also a "Doctor of Medicine".
He started working at the Dermatology Clinic literally from the student bench, being a volunteer between 2004 and 2006. After that, he was appointed as a resident at the Department of Dermatosurgery. In 2014, he became its head, and a year later he headed the Department of Skin and Venereal Diseases.
He is a part-time teacher at the Faculty of Medicine of the University of St. Kliment Ohridski . There are publications in Bulgarian and foreign scientific publications, as well as participation in international forums and conferences in the country.
What is psoriasis, Dr. Kantarjiev, and are there statistics on how many Bulgarians suffer from this disease?
- Psoriasis is a chronic relapsing disease affecting the skin and joints. It is clinically expressed with characteristic erythema-papulo-squamous lesions. Patients usually report red, scaly patches accompanied by itching. In about 34% of patients with psoriasis, the joints are affected, which is expressed by pain and stiffness. Worldwide, about 3% of the population suffer from psoriasis, in Bulgaria the latest statistics indicate at least 150,000 people affected by the disease.
How can we know that our skin problems are psoriasis and which part of our body is it affecting?
- Psoriasis mostly affects the skin of the elbows, knees, groin, hairy part of the head. In more severe forms, the involvement can be more extensive (abdomen, back, thighs). Plaques are usually itchy, covered in silvery-white scales, subside when we're at sea in the sun and seawater, and reappear in the colder months and with a little more stress in everyday life.
Many people, seeing the peeling skin, are terrified to even shake hands with the person. Is the disease contagious?
- Psoriasis is not contagious. However, patients tell us that they feel uncomfortable showing the affected parts of their skin, which is especially unpleasant in the summer, when mostly lighter clothes are worn.
How is the diagnosis made?
- In the 21st century, the "gold standard" for diagnosing psoriasis is taking biopsy material for histological examination. Psoriatic arthritis requires the intervention of a rheumatologist.
How fast does psoriasis spread on the skin and is there a proven method by which we can stop the disease in a certain phase?
- Sometimes patients report single plaques that remain unchanged in size and shape for a long time. After certain conditions of the body: viral infections, stress and others, rapid and progressive deterioration of the disease is possible.
Is psoriasis curable?
- The treatment of psoriasis is strictly individual, according to the severity, degree of skin involvement and joint involvement
We treat milder cases with local therapy, namely emollients, salicylic creams and oils. In more severe forms, it is necessary to include systemic therapy, which includes "Methotrexate" and "Neotigazone".
The dermatology clinic at the Academy of Medical Sciences is the most highly specialized center for the fight against psoriasis in the country. We have the most modern histopathological laboratory, through which, with the help of Prof. Elena Obreshkova and Associate Professor Valentina Broschilova behind the microscope, we make an accurate histological diagnosis within two to four days. Last but not least, the clinic is equipped with the latest generation of phototherapy equipment, through which we imitate the beneficial action of the sun's rays without causing harm. In severe cases involving the joints, a commission is held in the clinic to grant the so-called biological agents - expensive medications that are fully covered by the NHS.
In this case, can we talk about prevention and which people should comply with these tips?
- The causes of psoriasis are still not fully understood. Sometimes it arises on the basis of a genetic predisposition. It is believed that there is an association between psoriasis and some socially significant diseases, such as: arterial hypertension, diabetes, hyperlipidemia, autoimmune diseases, Crohn's disease. Provocative factors are mental stress, trauma, some infections. Unfortunately, during the autumn-winter season, our patients get worse, due to the lack of sunbathing and s alty sea water.
What are the most serious consequences that untreated psoriasis can lead to?
- The most serious consequences of untreated psoriasis are psoriatic arthritis, which can lead to pain, limited movement and definite joint distortions. With regard to the skin, severe, untreated forms lead to so-called erythroderma, or the involvement of a large area of the skin by lesions, which makes it highly susceptible to infection and is a life-threatening condition associated with edema and protein loss.
For more than 10 months, the world has been trapped by COVID-19. How does this affect your patients?
- The dermatology clinic at the Academy of Medical Sciences did not suspend its activities during the complicated epidemic situation in the country. We have not turned patients away, regardless of whether it is severe or milder cases. Of course, there are people who are worried about visiting hospitals because of the situation and postpone their treatment themselves. In such cases, we are here with advice on the use of local therapy at home.
Here is the moment to emphasize that the infectious disease clinic of the VMA, where patients with the new coronavirus are treated, is located in a completely separate building from the main one, 800 meters away from it. It has a special access mode, with modern disinfection systems. During all these months, the management's efforts were also aimed at "preserving" the main building, where almost all the Academy's clinics are located, from COVID-19, strict anti-epidemic measures were introduced to guarantee the he alth of both employees and our patients.