Psoriasis: The skin condition Kenya's health system continues to ignore

Psoriatic arthritis occurs when the immune system mistakenly attacks healthy joints and tissues, leading to inflammation. [iStockphoto]

It began quietly, almost unintentionally, in the middle of an assignment.

Bernard Orwongo thought it was just another ordinary day. Camera in hand, he moved between interviews and photographs, doing what he normally does as a photojournalist.

The forum in Nairobi did not immediately make sense to him. At first, it felt technical and distant. Between sessions, he searched online for clarity, but the information still did not explain what was unfolding in front of him.

Then the conversation shifted. People began speaking about skin conditions, flare-ups, misdiagnosis and years of treatment that never fully worked.

Bernard listened more closely. Something unfamiliar began to feel painfully familiar.

What he heard resembled the condition he had quietly lived with since childhood. When he finally spoke, it was not planned. “I just thought maybe it was something I picked up when I was young,” he later said. “I never really knew what it was.”

That moment of recognition opened the door to a larger story shared by many others at the forum, stories shaped by hospitals, schools, workplaces and homes where psoriasis became both a medical condition and a social burden.

Hidden burden

Across Africa, psoriasis remains widely under-recognised and underdiagnosed. According to the International Federation of Psoriasis Associations (IFPA), an estimated 3.5 million people live with the condition on the continent, though the real number is likely far higher because of poor diagnosis and limited data.

Psoriasis, commonly referred to clinically as PsO, is a chronic inflammatory skin disease affecting between one and five per cent of the global population. In Kenya, prevalence is estimated at around 3.5 per cent, though experts say the burden may be much higher.

Research globally has also shown racial disparities in psoriasis diagnosis and treatment. A 2022 US study found that patients with darker skin tones often waited significantly longer for diagnosis and frequently presented with more severe disease by the time treatment began.

Psoriasis has no cure. It is linked to pain, disability and other systemic illnesses, but its most immediate impact is often visibility. The skin tells the story before the patient can.

For many patients, the journey begins long before diagnosis. It starts with itching that never stops, flakes that keep returning and repeated hospital visits that provide temporary relief, but little clarity.

Children are often told they have dandruff, allergies or fungal infections. In some communities, the condition is linked to superstition or poor hygiene. What remains constant is uncertainty.

For 38-year-old Tina Ochsner, the condition began during adolescence. “My journey started when I was about 12 or 13 years old. It started on my scalp. We thought it was dandruff,” she said

Fortunately, a family doctor training as a dermatologist recognised the condition early. “I was diagnosed correctly from the beginning. At that age, I didn’t understand psoriasis was lifelong. I thought it would simply go away,” she said. 

Her family still explored herbal remedies because they feared strong medication. “I took a lot of herbals. I don’t know whether they helped, but my parents were worried,” she said.

Over the years, flare-ups kept returning. “When I’m clear, I forget about it. Then it comes back,” she said. 

At one point, severe flare-ups covered almost her entire body. Treatment and light therapy helped temporarily, but the symptoms later returned. “People think it’s contagious. Sometimes in public transport someone moves away, but when you explain, they relax,” she said. 

Mercy Waringa Munyui’s experience reflected the unpredictability of psoriasis across life stages.

She remembers a normal childhood before the flare-ups began. Her mother moved from clinic to clinic searching for answers. At one stage, doctors even tested her for HIV and AIDS while trying to understand her condition.

She remembers constantly cleaning flakes from her clothes and bedding as the condition worsened.

Her first pregnancy unexpectedly brought relief. “I even wished I could stay pregnant because my skin became calmer,” she said.

But the relief was temporary. “It came back again later. It always comes and goes,” she said. 

School stigma

For Moureen Makena, the condition became most painful during school years. “I think I discovered I had psoriasis when I was about eight years old,” she said. “It started on my face and ears. I wore long sleeves and stockings all the time.”

Before her family understood the condition, they searched for answers everywhere, including churches and repeated baptisms.

School became emotionally difficult. “I used to hide all the time,” she said.

Shared bathrooms became stressful. Social interactions carried constant fear of exposure. “I would wake up at 3am to bathe before anyone else,” she said.

She avoided sports, drama and other activities because she did not want classmates seeing her skin.

One incident in school remains unforgettable. “One day a teacher talked during assembly about sharing clothes,” she recalled. “I knew she was talking about me. That was my worst day.”

She believes psoriasis changed her personality. “I think psoriasis made me an introvert,” she said.

Even through the isolation, a few close friends stayed supportive. “They never made me feel different,” she said.

Lisa Kuria also learned to hide her skin. “I used to wear long sleeves all the time, whether it was hot or cold,” she said.

Even simple activities, such as washing dishes became moments of caution. Eventually, concealment became routine. “It just became normal,” she said.

Orwongo’s turning point came unexpectedly at the forum. He had lived with itching and flaking since childhood without ever receiving a proper diagnosis. “I never told anyone growing up. Not even my parents,” he said. 

At times, the itching became so severe he scratched against hard surfaces like stones, just to find relief.

When he eventually sought treatment, he received medication with no explanation. The forum finally gave him clarity. He later joined a patient association.

According to dermatologist Dr Evanson Kamuri Njoroge, many Kenyan patients live with psoriasis for years without proper diagnosis, often mistaking it for fungal infections, allergies or dandruff.

Dr Kamuri, who chairs the Psoriasis Association of Kenya and works as a consultant dermatologist at Kenyatta National Hospital, said plaque psoriasis is the most common form of the disease.

“These are the characteristic scaly patches many people recognise,” he said.

Some children develop guttate psoriasis after infections, such as streptococcal throat infections. “There are cases that come after infections people may not even connect to the skin,” he said.

Other forms are far more severe. Dr Kamuri warned against misuse of steroids and incorrect treatment, saying some patients develop dangerous complications. “When plaque psoriasis is treated wrongly, especially with inappropriate steroid use, it can become unstable and develop into pustular psoriasis. These patients become very sick and often require admission,” he said.

He also described erythrodermic psoriasis, one of the most serious forms, where the condition spreads across almost the entire body. “These are hospital emergencies. The skin barrier is destroyed almost like in burn patients,” he said.

Another complication is psoriatic arthritis, which affects joints and mobility.

Stress, he added, remains one of the biggest triggers for flare-ups. “You see psoriasis getting worse during exams, divorce, family stress and economic hardship,” he said.

The IFPA Forum Africa 2026 in Nairobi brought together patients, clinicians, policymakers and advocates under the theme: “Local Strength, United Action: Advancing Representation, Rights and Research.”

But even before treatment and specialist care, Kenya faces a more basic challenge, lack of data. “We actually don’t have data. We have been doing estimates,” said Stephen Mutiso from the Ministry of Health’s Division of Cancer and Non-Communicable Diseases.

The commonly cited estimate that psoriasis affects around three per cent of Kenyans is not based on a national prevalence study, but extrapolated from similar lower-middle-income countries. A prevalence study is now underway.

Across health facilities, psoriasis is often recorded simply as a “skin condition” alongside fungal infections and eczema. Unless patients reach specialist dermatologists, the disease disappears into generic outpatient statistics.

The result becomes circular: without diagnosis there is no data; without data there is no budget; without a budget there is no structured treatment system.

Despite links to diabetes, cardiovascular disease and mental health complications, psoriasis remains absent from Kenya’s National Non-Communicable Disease Strategy 2021–2026. “There has never really been a place for psoriasis within policy and programming,” Dr Mutiso said.

The next national NCD strategy, expected between 2027 and 2031, may provide an opportunity for inclusion.

Cost barriers

Meanwhile, treatment costs continue placing care beyond the reach of many patients. Psoriasis requires lifelong management, yet most patients pay out of pocket.

Methotrexate treatment costs roughly Sh3,000 monthly, while apremilast costs about Sh10,000. Biologic therapies are significantly more expensive. “There are many types of treatment. Psoriasis is not the same in every person,” Dr Kamuri said. 

Access also remains uneven, especially outside Nairobi and major urban centres where most dermatologists are concentrated.“Dermatologists gather where resources are available,” Dr Mutiso said. “You send one to a county without equipment and they become paralysed.”

One proposed solution is task-shifting, training nurses, clinical officers and general practitioners to recognise and manage psoriasis earlier.

Public perception remains another major barrier. Many people still view psoriasis as merely cosmetic rather than medically serious.

The clinical reality is far more complex. Dr Kamuri described psoriasis as a systemic inflammatory disease linked to hypertension, obesity, diabetes and high cholesterol, all of which increase the risk of heart attacks and stroke. “The skin is only where the disease shows itself,” he said. “Psoriasis can kill.”

The emotional burden is equally severe. Depression, anxiety and stigma often reinforce one another. “People think you have HIV. That stigma becomes part of the disease,” he said.

Dr Catherine Karekezi of NCD Alliance Kenya said psoriasis must now be understood as a systemic disease rather than simply a skin problem. “It has multiple systems involved. That’s why we talk about comorbidities,” she said.

These include cardiovascular disease, inflammatory bowel disease and severe mental health impacts. “There is also psychosocial involvement,” she said. “We don’t know what comes first, depression or psoriasis. It moves both ways.”

She added that severe psoriasis is increasingly being discussed within disability recognition frameworks because of its emotional, physical and financial impact.

Living beyond

Despite advances in treatment, psoriasis remains incurable. “We can only manage psoriasis,” she said. “We can put patients into remission, but it can always return.”

Still, newer therapies are helping many patients achieve longer periods without symptoms and significantly improved quality of life.

Ultimately, clinicians say the conversation comes back to something deeply human. “Quality of life is everything,” Dr Karekezi said. “How do I feel? How do I dress? How do people perceive me? That is what we are trying to improve.”

As Kenya prepares its next national health strategy, advocates say the question is no longer whether psoriasis exists, but whether the system is finally ready to see it.

IFPA President Ingvar Águst Ingvarsson said lived experience must remain central to policy decisions. “People with psoriatic disease must be present when decisions are made about them,” he said.

“We cannot treat people with evidence that was not built for them.”