It was in 1991 when a doctor disclosed to Gérard Rugambwa, that he had psoriasis, a skin disorder with no cure that causes skin cells to multiply up to 10 times faster than normal. It all started after he observed some scaly itch patches on his left leg and, after some days, it spread to the right leg too.

At first, it wasn’t much of a bother to him, until after three months, when he discovered cream flakes in his hair every time he combed.

He had no idea it was psoriasis. He consulted a doctor who was clueless about the illness. The doctor advised him to wash his hair with shampoo, which simply made the situation worse.

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"Luckily, I met a Rwandan specialist working in Bujumbura where I had travelled for a conference. He saw me and immediately recognized the disease and informed me that he would treat it. He explained to me what psoriasis is and its symptoms and he offered me some medication and assured me to check up on me regularly. Ever since then, I am on medication, and I am trying to manage it,” Rugambwa said.

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He uses different expensive medications. One of them is Daivonex cream which goes for Rwf80,000. He was advised to use it twice a day but he applies the cream once a day so that it can last longer. One of the challenges he has been encountering is people staring at him and stigmatizing him without bothering to understand his condition. Rugambwa fears appearing in public, or wearing clothes of his choice as his legs and sleeves are always covered to avoid displaying the patches.

In 1998 when Rugambwa got a job in an Adventist school, some of the health teachings revolved around the essence of healthy living. It was from then, that he started eating healthy foods including veggies and fruits, getting enough rest, and living a healthy life. This has helped him get better.

Experts say that people with psoriasis are frequently stigmatized and excluded from normal social environments. They commonly report experiencing loneliness, isolation, and feelings of being unattractive.

There is a significant cost to mental well-being such as higher rates of depression. Some have lost opportunities in professional life and high treatment expenses can add to the socioeconomic burden for people suffering from the disease.

In Rwanda, psoriasis is still perceived by some people as witchcraft, or mistaken for HIV.

To join efforts for awareness and advocacy, the Rwanda Psoriasis and Psoriatic Arthritis Organisation (RPAO) was formed in April 2024, and Rugambwa is the deputy legal representative.

A chronic inflammatory skin disease

On June 2, RPAO organized a press conference in Remera to shed light on the disease. During the event, Dr Alice Amani Uwajeni, a dermatologist at the University Teaching Hospital of Kigali (CHUK), explained that psoriasis is a chronic inflammatory skin disease with a strong genetic inclination and autoimmune pathogenic traits. According to experts, three factors are at play in the pathogenesis – the origination and development of a disease – of autoimmune diseases: genes, immune system, and the environment where the patient lives.

Autoimmune disease happens when the body&039;s natural defense system can't tell the difference between your own cells and foreign cells, causing the body to mistakenly attack normal cells.

Dr Uwajeni noted that despite the refinement of the targeted therapies, psoriasis is a treatable but, so far, not curable disease.

On May 24, 2014, the 67th world health assembly of the World Health Organization (WHO) passed a resolution on psoriasis, and all member states acknowledged the burden of psoriasis and committed to increase their efforts to fight the stigma and unnecessary exclusion of people living with the condition.

"Psoriasis is not transmitted; it has a genetic component that is supported by patterns of familial aggregation. First and second-degree relatives of psoriasis patients have an increased prevalence of developing psoriasis, while monozygotic twins [identical twins] have a two to threefold increased risk compared to dizygotic twins [fraternal twins],” she explained.

According to Dr Uwajeni, the inflammation is not limited to the psoriatic skin but it affects different organ systems which is why it has been assumed that psoriasis is a systemic entity rather than a solely dermatological disease.

Psoriasis patients, she explained, exhibit increased hyperlipidemia, hypertension, coronary artery disease, type 2 diabetes, and increased body mass index. Hyperlipidemia (high cholesterol) is a common problem with fats building up in your arteries. This increases your risk of a stroke or heart attack.

Smoking tobacco can not only increase one’s risk of developing psoriasis, but can increase the severity of the disease. Alcohol is also thought to be a psoriasis trigger.

Dr Uwajeni explained that some of the ways of prevention are by precluding damage associated with inflammation and preventing future damage, and reversing existing damage conditions caused by inflammation.

Rwanda encounters are a lack of available data on the condition and studies on quality of life in people with psoriasis, in addition to few dermatologists, the medical practitioner noted, highlighting some of the challenges.

At the moment, the country has only 13 practicing dermatologists, serving a population of 13.2 million.

Dr Uwajeni said: "There is a review of essential drugs by the Ministry of Health and all hospitals each fiscal year, and epidemiological data in psoriasis is expected to be available by 2025. We shall have statistics of the quality of life among people affected with psoriasis in Teaching Hospitals in Rwanda by 2026.”