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Psoriasis: Rising Global Burden and Policy Priorities
Psoriasis: Rising Global Burden and Policy Priorities
Context: Recent findings published in JAMA Dermatology highlight that global psoriasis incidence has steadily increased from 1990 to 2021 and is projected to rise further until 2050.
What is Psoriasis?
- Psoriasis is a chronic, immune-mediated inflammatory skin disease characterised by rapid skin-cell proliferation. It is recognised by WHO as a serious non-communicable disease (NCD) due to its long-term nature, comorbidities (cardiovascular disease, arthritis), and psychosocial impact.
- The Global Burden of Disease (GBD) 2021 estimates show a steady rise in incidence across both sexes between 1990 and 2021, with projections indicating continued growth up to 2050.
What are the Major Symptoms?
- Dermatological Symptoms
- Red, scaly plaques typically on elbows, knees, and scalp.
- Itching, burning, and cracking of skin.
- Nail involvement (pitting, onycholysis).
- Systemic and Associated Conditions
- Psoriatic arthritis, affecting nearly 20–30% of patients globally.
- Increased susceptibility to metabolic syndrome, depression, and cardiovascular disease (WHO Global Report on Psoriasis, 2016).
What are the Major Causes Behind the Rise?
- Improved Detection & Reporting: Higher clinical awareness, better dermatological services, and the post-2013 boom in systemic therapies have increased detection—highlighted in JAMA Dermatology (2025) estimates projecting rising incidence till 2050.
- Environmental & Lifestyle Factors
- Urban pollution, high-fat diets, and stress act as inflammatory triggers.
- The “hygiene hypothesis” suggests low microbial exposure in high-income settings may heighten immune dysregulation.
- Regional Data Gaps: Limited registry systems in South Asia and Sub-Saharan Africa mean under-ascertainment, making the apparent burden higher in Western Europe and North America.
- Demographic Patterns: Incidence rises significantly in men after age 30, indicating biological and occupational exposures as contributing factors.
What Medical Remedies and Policies Can Be Adopted?
- Medical Interventions
- Topical corticosteroids, vitamin D analogues, and phototherapy remain first-line treatments.
- Biologic therapies targeting TNF-α, IL-17, and IL-23 are effective for moderate-to-severe cases.
- Tele-dermatology can expand access—aligned with India’s Ayushman Bharat Digital Mission framework.
- Public-Health and Policy Measures
- National NCD registries: India can integrate psoriasis into the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) for surveillance.
- Health-system strengthening under the Economic Survey’s emphasis on digital health infrastructure enables early diagnosis and reduced out-of-pocket expenditure.
- Lifestyle-based prevention campaigns focusing on weight control, smoking cessation, and stress management.
- Insurance coverage expansion under PM-JAY to include biologics for severe psoriasis, reducing financial burden.
- Research funding through ICMR for studying environmental triggers relevant to India.
