Psoriasis

Emotions, mental health and having psoriasis: overview

Having psoriasis was described by some young people we talked to as frustrating and annoying, and could negatively affect confidence and self-esteem. Zara felt she had been labelled as “the one with the weird feet” and heard people make “snide comments and jokes”. Others said they weren’t too affected emotionally by having psoriasis or that they had only the occasional “grey day”.
There’s not a straightforward relationship between severity (how much psoriasis a person has or how strong their symptoms are, like itching and pain) and the emotional impacts. Some people had fairly mild psoriasis but found it very upsetting. Being told that it’s “just a skin condition” made Abbie “keep it to myself rather than opening up” about the emotional side. 
People talked about their feelings about psoriasis, related to: Some people felt embarrassed and worried about what others might think. This includes concerns about the sight of psoriasis, having it in intimate areas, skin flakes, treatments or other people thinking they could ‘catch’ it. Itchiness can be frustrating and, for some, their skin was painful. Zara enjoys playing sports but finds having psoriasis on her feet makes it uncomfortable and she has to be careful to avoid infections. Many felt good when their psoriasis cleared up, but were disappointed if it returned.
Zara was diagnosed when she was little and didn’t understand much about the causes but felt angry. Others, like Louis, were relieved to get a label for the symptoms. Russell and Jack looked up their symptoms online before getting a doctor’s diagnosis of psoriasis, which caused some worry.
Some said they would rather do particular activities than avoid them, even if it meant their psoriasis would be more irritated. Stress was a major trigger for many people’s psoriasis. Some talked about a “vicious cycle”: stress leads to itching which makes the psoriasis worse and causes more stress. Being unable to sleep enough can add to this. Megan finds the combination of stress and tiredness especially hard when she’s revising for exams. Some found hobbies and socialising helped reduce stress.
Many people talked about feeling frustrated with repeat appointments, especially if they felt there was no improvement with their skin. Some people found it difficult to get a dermatology referral or felt annoyed about having long waits for appointments. A few people were disappointed that their doctors had not told them certain things about psoriasis, like the link with psoriatic arthritis. Many people said they wanted their health professionals to have a better understanding of the emotional side of having psoriasis. Some filled in questionnaires about the social and emotional impact of their psoriasis, but found the scores weren’t discussed in detail with them by their dermatologists. Some people felt comfortable with health professionals they had met many times.
  • using treatments
Some people said psoriasis treatments, their side effects and impracticalities impacted on them emotionally. It could be frustrating if treatments didn’t work or if they further irritated the skin. A few people worried about serious health risks from some medicines, including skin thinning with over-using steroids creams. Some said they disliked having procedures with needles, such as with blood tests and systemic medicine injections. Many people said they felt self-conscious about the ‘unpleasant’ feel, look and smell of topical treatments which could attract attention from others. Another concern was the financial cost of treatments and the time it took to use them. However, some people also talked about being excited to try new treatments and feeling hopeful that these might help with their psoriasis.
  • the uncertainty of the future with psoriasis
People we talked to worried about how severe their psoriasis symptoms might become and whether they could develop associated health conditions, such as psoriatic arthritis. Worries about treatments included risks and side effects, what would happen if a treatment stopped working and how many times phototherapy could be used. Lucy worried about whether psoriasis might impact romantic relationships before she met her now-fiancé at university. Louis had post-viral psoriasis with difficult symptoms for a few weeks: it was a “scary thing to hear” doctors say that they didn’t know how long it would last.
Mental health and psoriasis

Some people felt psoriasis had contributed to mental health issues. Simon thinks his skin was a “major factor” in his depression because it can “wreck your social life and your self-esteem”. Sofia felt anxious in social situations which she says limited the number of friends she made. Louie says psoriasis is linked to the depression and anxiety he’s had but feels he has mostly overcome now.
A few people had been to counselling referred to by their doctor (see also the section on sources of information and support). Most found it helped, but Zara says her experience of counselling was “a waste of time” because “talking about it always made it seem more real and I always quite liked to block it out”. The impact on confidence and self-esteem was a big part of psoriasis for many. You can read more about this here.

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