Psoriasis And Mental Health

Introduction

Psoriasis is a chronic skin condition that can negatively affect people’s body image and expose them to stigmatisation and prejudice. These stress factors can take a toll on the mental health of people living with the disease, which we will discuss in more detail in this article. We will also provide important tips on what to do if you or a loved one are struggling with this issue. 

What is psoriasis?

Psoriasis is a non-contagious chronic inflammatory skin disease. It can develop into different severity levels, going from a mild condition that causes minimal discomfort, to a severe condition that brings a significant burden to people suffering from it. It affects between 2 to 4% of the world’s population. The first episode most often occurs between the ages of 20 and 30 years and between the ages of 50 and 60 years, with an equal risk for men and women.^1-3

The disease occurs in cycles, with periods of exacerbation and periods with no symptoms at all. This characteristic of the disease, combined with the fact that there is still no cure for it, means that people living with the condition need to manage it throughout their whole life, which can become a burden to their mental health.^1-4

Symptoms

The symptoms caused by psoriasis depend on the type of psoriasis developed. The most common type is plaque psoriasis, which commonly causes well-defined dry patches and scales in the scalp, back, elbows, and knees, which can be itchy and/or painful. Less common types of psoriasis include nail psoriasis, guttate psoriasis, and inverse psoriasis.^1-3

Effects of psoriasis on mental health

Psoriasis is a chronic disease that can cause painful and debilitating symptoms. In addition to creating lesions in parts of the skin that are frequently visible to others, this illness exposes its patients to social stigma and prejudice. Besides, people’s body image and self-esteem can be negatively affected by the lesions, which further worsens the burden of the disease.^4-6

Therefore, psoriasis may be psychologically challenging for many people, causing significant mental suffering. In fact, people with the condition experience higher rates of depression, anxiety, emotional stress, and low self-esteem compared with people without the condition.^4-8

Increased prevalence of anxiety and depression

People living with psoriasis are 50% more likely to suffer from depression and are more likely to report suicidal ideation than people without the condition. Similarly, people affected by the disease are more likely to suffer from anxiety disorders, with the prevalence of anxiety varying from 7 to 48% in this population. In this context, it is reported that anxiety symptoms get better following psoriasis treatment, which highlights the importance of proper management of the disease.^4-8

The relationship between psoriasis and mood disorders, such as anxiety and depression, is believed to have a biological underlying mechanism but is also related to the stigma and prejudice associated with the disease. Additionally, it has been well described that psoriasis and anxiety exacerbate one another.^4-8

Flare-ups and social anxiety

The body areas most affected by psoriasis are the scalp, back, elbows, and knees, which are usually easily visible to others. This exposes people experiencing flare-ups of the condition to stigma, prejudice, and social exclusion. In this challenging context, people experiencing psoriasis flare-ups might avoid certain places or situations, which can lead to feelings of loneliness and isolation. Additionally, it can cause people to experience social anxiety when they are exposed to certain environments or situations while suffering from flare-ups. This also works the other way around, as anxiety can worsen psoriasis symptoms or even lead to flare-ups.^4-8

Decreased self-esteem

The skin lesions caused by psoriasis can negatively affect people’s body image which combined with stigma, social rejection, and prejudice from others decreases people's self-esteem and self-confidence.⁹ All these stress factors can worsen psoriasis symptoms, and people can enter into a “vicious cycle” that might be difficult to interrupt. Thus, it is of the utmost importance to care for the self-esteem and well-being of people living with psoriasis, and educate others about the disease, to prevent prejudice and stigmatization. ^4-8

If you’re worried about your or your loved one’s mental health

If you are living with psoriasis and worried about your mental health, do not hesitate to contact your general practitioner or your dermatologist and share your concerns, as there are many ways that they can support you, such as through advice and treatment, if needed. Additionally, speaking about your experiences and hearing from others living with the condition can be extremely helpful, and many support groups are available. Participating in support groups can decrease your feelings of loneliness, and improve your self-esteem, besides allowing you to learn about practical matters on how to deal with the disease. 

It is also very important that you follow the prescribed treatment, as this will prevent flare-ups of the disease and all the emotional challenges that come with it. Lastly, when living with a chronic and autoimmune condition like psoriasis, prioritising your self-care is essential. This includes maintaining a healthy lifestyle with a balanced diet and regular physical exercise, as these practices can reduce your risk of flare-ups and improve your physical and mental health in general.

If you have a loved one that is living with psoriasis and you are worried about their mental health, you can support them in many ways. Besides showing care and concern, also stimulate them to seek support through their healthcare team and in support groups, help them to follow the prescribed treatment, and to keep a healthy lifestyle. 

Conclusion

Psoriasis is a chronic inflammatory skin disease that causes dry patches and scales in the skin, which are usually itchy and/or painful. Living with the symptoms itself can affect people’s mental health, but the social stigma and prejudice that comes with it also play an important role in the burden of the disease.^4-8 These negative effects happen to such a large extent that people living with psoriasis have increased rates of anxiety and depression and decreased self-esteem when compared to people that do not suffer from the condition.^4-9 However, there are many types of effective support available if you or a loved one is struggling with this issue. Additionally, following the prescribed treatment and maintaining a healthy lifestyle are also essential steps to improve your mental and physical health.