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Psoriasis and Your Emotional Health

Psoriasis can have a devastating effect on every aspect of a person's life. It can affect your relationships, your sense of self, your romantic life, your job, and your finances.

Many people think of psoriasis as just a skin disease.  Sure, it may be itchy and uncomfortable.  But how bad could living with psoriasis really be?

Yet while psoriasis symptoms may be on the skin, psoriasis is no superficial condition.  Psoriasis can have a devastating effect on every aspect of a person's life.  It can affect your relationships, your sense of self, your romantic life, your job, and your finances. 

Despite all the suffering, too many people living with psoriasis aren't getting help. "There are lots of patients out there who have just given up and stopped seeking treatment," says Robert Brodell, MD, a dermatologist at Northeastern Ohio Universities College of Medicine.  They're muddling through alone.

And even people in treatment may find that the emotional impact of psoriasis gets overlooked.  "I think that the majority of dermatologists still don't talk about the very serious psychosocial issues related to psoriasis," says Alan Menter, MD, president of the International Psoriasis Council.  With psoriasis, focusing on the skin alone may not be enough.

What do you need to know about the emotional effect of living with psoriasis? And how can you deal with it? Here are some answers. 

Stigma of Psoriasis

Research shows the huge impact that psoriasis can have. Experts cite studies that track the quality of life of people with various illnesses. "Psychologically, the only disease that debilitates people more than psoriasis is depression," says Mark Lebwohl, MD, chairman of the medical board of the National Psoriasis Foundation. Psoriasis has a more profound and more negative effect on person's well-being than every other disease -- including diabetes and cancer.

So why does psoriasis have such a huge impact? For many living with psoriasis, it's the stigma -- how other people react to you, and how that makes you feel.

Stigma can quickly cause those living with psoriasis to change their behavior. As other people start to notice their skin, they become more self-conscious and anxious. They start covering-up their psoriasis and making excuses for it. They opt out of social situations. Severe stigma can alter a person's whole personality, changing a confident, outgoing person into someone ashamed and withdrawn.

If psoriasis symptoms worsen, the person pulls back even more. It's a snowballing effect that puts people with psoriasis at higher risk of other problems, like anxiety and depression.

"Depression is a very serious issue for people with psoriasis," Menter tells WebMD. One study showed that 25% of people with psoriasis are also depressed. One out of ten people living with psoriasis has thought about suicide.

Of course, most people living with psoriasis don't become clinically depressed. But even mild cases can result in chronic stress. Menter says that people who are between flares or who only have minor symptoms still live with a basic anxiety: what if it gets worse?

All that psoriasis stress doesn't only affect your emotional health. Stress is also a well-established trigger for flares.

"Stress makes the psoriasis worse, and the psoriasis makes the stress worse," says Brodell. "You get into a vicious cycle."

The Stress of Psoriasis Treatment

In addition to the stigma of psoriasis, a sometimes forgotten cause of stress is treatment itself. Psoriasis treatment can be demanding.  Many treatments require a lot of commitment.

"Having a disease like psoriasis is a lot of work," says Phillip Mease, MD, a Seattle rheumatologist who specializes in treating psoriatic arthritis. "You have to arrange for all these doctor visits and treatments, to advocate for yourself with insurance companies. It's almost like having a part-time job."

There is good news: new biologic medicines have transformed treatment. "We now have the medicines that can clear most psoriasis patients in just 10 to 12 weeks," says Menter.

But the medicines are expensive. Treatment with biologic medicines can range from $14,000 to $28,000 a year, says Brodell. The price can force people living with psoriasis to make tough decisions.

"Some people basically have a choice between getting treatment or selling their houses," Brodell tells WebMD.

And even if you're not using these cutting-edge medicines, psoriasis treatments can still cost you. Phototherapy might last months or even a year. Not only will you have to pay for weekly treatments, but you might have trouble fitting them into your work schedule.

Tips for Living With Psoriasis

Considering the serious effects of psoriasis, what can you do to stay emotionally healthy while living with psoriasis?

  • Stay connected. Psoriasis is a condition that can pull you away from others. Don't let that happen. You need the support of the people you trust and care about right now. So even when you're feeling down or self-conscious, try to push through it. Also, consider joining a support group for people coping with psoriasis -- the National Psoriasis Foundation sponsors them throughout the country.
  • Find a doctor you trust. Choosing the right doctor might not seem relevant to your emotional state, but it is. If you have confidence in your doctor, you'll probably be more confident in your treatment. That can give you a more optimistic view in general. A good doctor can also advise you on issues beyond the medical. For instance, if you're having trouble affording treatment, your doctor might be able to get you in touch with pharmaceutical programs that give away medicine for free. Or he or she might tide you over with free samples.

    However, if you feel like your doctor is ignoring your concerns -- or just handing you tubes of cream that never help -- think about seeing someone else. Find a dermatologist who is a psoriasis expert and who knows about all the treatment options.
  • See a therapist. Many people living with psoriasis seek out therapists. Will therapy solve everything? Will it prevent you from feeling humiliated if a stranger keeps staring at the plaques on your arms? No. But it can help you learn better ways to cope with the social situations that you'll encounter. See if your dermatologist has any recommendations for a therapist who has experience treating people with psoriasis and similar conditions.

    Of course, if you feel like anxiety is getting in the way of your life, or that you might be depressed, you need to get help right away.  Depression isn't inevitable for people living with psoriasis.  Therapy -- and sometimes medicine -- will help.

Living With Psoriasis: the Benefits of Treatment

Obviously, you don't want a doctor who only considers your skin and isn't interested in the emotional impact of living with psoriasis. But there is a flip side -- sometimes, the best way to resolve the emotional problems caused by psoriasis is to control the disease itself.

"It's been well shown in studies," says Menter. "As you improve the psoriasis symptoms with treatment, you see simultaneous improvements in their emotional state, stress, depression, fatigue, the health of their relationships, their sexual health, and their functionality at work. It's paralleled almost week by week."

So never ignore the emotional suffering caused by psoriasis -- get help. But by the same token, don't ignore the underlying disease either. No matter how severe your case, no matter how many failed attempts you've made before, there are very good treatments out there.

"The first thing I tell people with psoriasis is you don't have to live with your disease," says Menter. "We have the tools to help you now."

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