Small spots started appearing on Caroline Almeida’s arms, elbows, knees and scalp when she was 12 years old.
Over the months, the size of the reddish marks increased and small scabs came out of the skin when the young woman scratched, which attracted her mother’s attention.
Born in Cambuí, Minas Gerais, the family lived in São Paulo at the time and sought help from the public health system.
Caroline was referred for a consultation with a dermatologist, who took a small skin sample to perform a biopsy.
The result, which showed inflamed cells, confirmed the doctor’s suspicion that the young woman was in pain psoriasisa chronic, noncontagious, autoimmune skin disease, meaning that a person’s immune system attacks healthy cells.
About 2.6 million Brazilians suffer from the disease, according to an estimate raised by the SBD (Brazilian Society of Dermatology). But, according to a survey Data sheet released in October 2020, only 6% of the population recognizes the lesions caused by psoriasis.
“Having a disease that everyone sees causes suffering for many”, says psychiatrist Elson Asevedo, technical director of Caism/Unifesp, the hospital that houses the Department of Psychiatry of Unifesp (Federal University of São Paulo), adding that the lack of knowledge can lead some to mistakenly think they can be contaminated by patients who have the spots.
‘I have been called a leper and disgusting’
“At first, treatment was limited to topical options, such as scalp lotions, ointments, and creams, all with lab-manipulated formulas. treatments,” he says.
A few years later, already a teenager, Caroline says she won few friends during her school years and was bullied with aggressive comments from classmates.
Every time an episode of fatigue or intense sadness occurred, Caroline says the manifestations of psoriasis worsened. “Every negative emotion, whether I was very nervous, stressed or even sad, my skin reacted to every negative emotion.”
Why do emotions affect the skin?
Being “jittery” or “purple with rage” are popular informal expressions, but they have a biological explanation.
The dermis and mental health are directly related: the skin, the largest organ of the human body, and the nervous system, of which the brain is the central organ, have the same origin during the formation of the embryo.
Both derive from the ectoderm, the external layer of the embryo, which undergoes a fold during formation and forms the so-called neural tube.
“It is a direct line between stress hormones and skin receptors,” explains Márcia dos Santos Senra, coordinator of the Psychodermatology Department of SBD.
What is psoriasis and why can it cause heart problems?
Another interesting aspect of the relationship, explains psychiatrist Elson Asevedo, is the immunological component.
“In autoimmune diseases, like psoriasis, the body builds a defense against elements of itself: it’s deregulation. depression, we now know, also undergoes this type of immunological alteration, so there is a ‘two-way street’ between the diseases. One of the psychiatrist’s leading current hypotheses is that immune impairments for depression increase the risk of autoimmune disease.”
A more direct social influence also affects the relationship. If someone with psoriasis experiences emotionally traumatic episodes, such as abuse, violence, bullying, loss of a loved one or separation, they are more likely to develop it. anxietydepression or other psychiatric conditions, which in turn worsen the dermatological conditions.
“I was in so much pain that I asked to die”
At 19, Caroline met her daughter’s father. “At first the relationship was wonderful, but over time she started blaming me for everything, it was abusive. Until 7 months of pregnancy, my psoriasis didn’t hurt and I had few pimples. I was happy to be carrying my daughter.”
“Shortly before her birth, a very bad argument, which almost ended in an assault, and in two, three days, my skin got so bad that I had to be hospitalized in Cambuí.”
Caroline says she has been given several medications, but none have been able to control the condition.
“The doctor who attended me said that he was not able to handle it, that it was better to transfer me. The same day I went to Pouso Alegre. My skin was completely open, exposed, so I had to get my whole body bandaged “.
The search for an effective treatment
An immunosuppressant drug considered safe for Caroline’s pregnancy came from Belo Horizonte and took three days to arrive.
“I’ve improved by about 50% and have already left the hospital, which I was unable to do when I arrived.”
Exactly one month after her discharge, in March 2017, the young woman returned to the hospital for the birth of her daughter.
On the advice of the doctor, Caroline therefore began the treatment with a drug of the class called immunobiologicals, which are drugs produced by the cellular biology of human DNA and programmed to modify strategic points of the defective immune response that occurs in cases of autoimmune diseases.
“These drugs are indicated for patients with severe or moderate psoriasis who have tried other types of treatment and have not been successful. It is not the first option for anyone because there are some side effects,” indicates dermatologist Márcia dos Santos Senra.
Among these, Senra cites the possible impairment of liver enzymes and worsening lung conditions for patients with pre-existing conditions. Other possible reactions are hypertensionnausea, mood swings and anxiety.
“Regular follow-up with a doctor who is experienced with this class of drugs is necessary,” recommends the doctor.
Immunobiologics are now available from SUS
Caroline receives the drug through the agreement, but there are five immunobiologic options available free of charge from the SUS (Sistema Único de Saúde) for more severe cases that are resistant to other treatments.
“In four months of taking the drug I had no more spots on my body, today nobody says I have psoriasis and I haven’t had attacks for eight months. Before, the maximum I had was one month”.
“I think I would have suffered less if treatment had been available during my adolescence. I would have gone to the farm that the school rented for my graduation, I would have done so many other things… Only I know what it’s like to have people watching to me with disgust.”
Senra stresses that it is a “wonderful victory” for the country to have these drugs freely available, but reiterates that practices that work positively on patients’ emotions are still essential.
“Techniques such as meditation and self-perception help the patient begin to understand what triggers his mental crises and how to deal with negative emotions, such as anger and fear, which are examples of emotions that damage the system immune. The therapeutic work of identifying, sensing and coping is daily work that should not be ignored.”
Caroline, who is now 25 and works as an inker [profissional que finaliza tecnicamente peças de design ou publicidade]she claims to exercise this self-control as part of her treatment.
“Today I try not to get carried away by momentary emotions, but rather to focus on myself – after all, in the end, it will be reflected on me.”
This text was originally published at: bbc.com/portuguese/brasil-63824259
