R. Morgan Griffin
Louise Chang, MD
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
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
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
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.
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
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ashamed and withdrawn.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
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."
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
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.
Considering the serious effects of psoriasis, what can you do to stay
emotionally healthy while living with psoriasis?
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
SOURCES: American Academy of Dermatology web site: "Research Shows that People
with Psoriasis at Increased Risk for Developing Other Serious Medical
American Academy of Dermatology's PsoriasisNet web site: "Psoriasis
Robert Brodell, MD, professor of internal medicine, dermatology section,
Northeastern Ohio Universities College of Medicine, Rootstown,
Mark Lebwohl, MD, Chairman of the Medical Board of the National Psoriasis
Foundation; Chairman of the Department of Dermatology, Mount Sinai School of
Medicine, New York University.
Philip Mease, MD, rheumatologist, Seattle Rheumatologist Associates and the
Swedish Medical Center in Seattle; spokesperson, National Psoriasis
Alan Menter, MD, president, International Psoriasis Council; director,
Psoriasis Research, Baylor Research Institute, Dallas.
National Psoriasis Foundation web site: "Support People."
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