PSORIASIS NEWS
Living With Psoriasis: Emotional Health
Psoriasis isn't just a skin disease
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 Severe stigma can alter a person's whole personality, changing a confident, outgoing person into someone ashamed and withdrawn.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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Living With Psoriasis: Tips for Family and Friends
Living with psoriasis can be tough -- not just for the person with the diagnosis, but for his or her loved ones too. It's a condition that can affect entire families, both emotionally and sometimes financially.
If you have a friend or family member with psoriasis, you may want to help but don't know where to start. Here's some advice.
- Learn about the psoriasis. Start with the basics. If you have a loved one living with psoriasis, it's important that you really know about it -- the symptoms, the causes, and psoriasis treatments.
- Ask loved ones with psoriasis what they need. Don't make assumptions about what sort of help psoriasis patients want. Ask. Do they need someone to tag along to doctors' appointments or help evaluate treatment options? Do they want someone who will listen? Or just someone who will make them laugh -- and not mention the word "psoriasis" once?
- Encourage your loved one to get psoriasis treatment. Lots of people living with psoriasis get frustrated with treatments that haven't worked and give up completely. While that's understandable, it's not a good idea. The vast majority of cases can be controlled. So if your loved one has stopped seeing a doctor, urge him or her to try again -- perhaps with a new dermatologist who has expertise in treating the condition.
- Be positive, but not pushy. Lots of people living with psoriasis start to pull back from life, to isolate themselves. If you can, try to intervene. Encourage your loved one to stay connected with friends and do the things that he or she enjoys. But do it gently. If you try to force your loved one into doing things he or she is not ready to do, that person could just become anxious and upset.
- Reduce stress around the household. Stress is a known trigger for psoriasis. Obviously, no one's home can ever be stress-free. But talk to your loved one about things you could do to lower his or her stress level.Maybe swapping some responsibilities or allowing that person to have extra time to rest could be a good way of offering psoriasis support.
- Treat signs of depression seriously. Depression and psoriasis can go together. One study showed that one out of four people living with psoriasis were also depressed.Since depression is a serious illness, don't ignore any signs -- like persistent sadness or loss of interest in daily activities. Encourage your loved one to see a doctor or a therapist as soon as possible.
- Don't take on too much. Obviously, your loved one needs your help and support right now. But if your loved one is an adult, you shouldn't take on all the responsibility yourself. If you take charge of every aspect of that person's life and treatment, you'll wind up worn out and resented. Remember, your job isn't to take care of your loved one; it's to help that person take care of himself.
- Take care of yourself. Caring for someone with a debilitating condition can be draining. It's important that you maintain your own life too, something distinct for yourself. If your loved one has become more reclusive, you still need to stay connected. Take time to go out with friends and do things you like to do. If you start to feel overburdened, ask other friends or family members to pitch in. And if you're getting seriously overwhelmed, check in with a therapist. Running yourself ragged won't help either you or your loved one in the long-term.
6 Tips for Winter Psoriasis Treatment
Winter brings dry air, colder temperatures, and reduced exposure to sunlight – all of which can worsen the symptoms of psoriasis. What can the 7.5 million Americans who suffer from psoriasis due to prevent a flare-up of symptoms? Are there winter tips for psoriasis treatment?
Yes, and good self-care for your psoriasis in winter isn't difficult once you know what to do.
- Elizabeth A. Abel, MD, an adjunct clinical professor of dermatology at Stanford University School of Medicine in California
- Lakshi Aldredge, MSN, RN, ANP-C, a nurse practitioner at the Portland VA Medical Center in Oregon
Along with taking your psoriasis medication, they say, follow these six psoriasis treatment tips to keep inflammation, patches, and itchy skin in check.
Psoriasis Tip 1: Think Twice About Long, Hot Showers
Make your showers short, sweet, and lukewarm, says Abel, who cares for many psoriasis patients. "Avoid hot water," she says. "Hot water feels good at the time, but the itching can rebound when you get out."
Cutting down on showers is best in winter, when indoor air tends to be dryer. "No more than one a day," Abel says. "And no scrubbing. It can be irritating, and when skin is irritated, psoriasis gets worse." Also, she recommends that you pick soaps for sensitive skin.
Psoriasis Tip 2: Slather on Moisturizer After Baths and Showers
Dermatologists and other health professionals who care for psoriasis patients can't say it often enough: Moisturize, moisturize, moisturize. One of the best times is after a shower.
"Put moisturizer on your skin 3 to 5 minutes after you towel off after a shower," Aldredge says. Doing it quickly makes a difference, she says. "It helps seal in moisture so the skin doesn't get as dry."
What kind? "Lotions are easiest to apply all over," Abel says. "But creams and ointments are more moisturizing than lotions."
"Plain old petroleum jelly is one of the best moisturizers in the world," Aldredge says. But people are often reluctant to use it, she knows, because of its "greasiness." She suggests: "Use it at night or after a shower, and wear old sweats or pajamas. It will soak in after an hour or two."
Psoriasis Tip 3: Look to the Light for Therapy
The use of light therapy can help clear up patchy, scaly skin, Abel says, although the time commitment can be a problem, as most people with psoriasis need multiple sessions. Also called phototherapy, light therapy has been a standard of psoriasis treatment for a long time. The premise is simple: ultraviolet light slows the rapid growth of skin cells that occurs in psoriasis and can clear the symptoms for a period of time (while normal skin typically replaces itself every month or so, in psoriasis that process can speed up to three or four days).
One option is called psoralen UVA, or PUVA. "It is a type of photo chemotherapy, in which the patient takes a light-sensitizing medication, psoralen, by mouth, then an hour and a half later is exposed to long-wave, ultraviolet light in the office," Abel says. PUVA requires about 25 treatments, according to the National Psoriasis Foundation, and there are long-term risks of skin cancers with light therapy, so that risk must be weighed. PUVA has been in use since the last 1970s but is less common now, Abel says, due to a newer type of phototherapy called narrowband UVB or ultraviolet B. This type emits the part of the UV light spectrum most helpful for psoriasis.
About 30 treatments are needed for UVB to clear the skin, according to the National Psoriasis Foundation.
Psoriasis Tip 4: Get a Winter Tune-Up on Your Psoriasis Medications
If your psoriasis is getting worse, or usually does in the winter, it is a great time to check-in with your physician for a medication tune-up. Your doctor can assess whether the psoriasis medications you are using -- topical, systemic, or a combination -- are working as well as possible.
Common topical psoriasis treatments that you rub on your skin include over-the-counter products such as salicylic acid and coal tar, and prescription topical creams such as Dovonex (synthetic vitamin D3), Tazorac, and corticosteroid medications.
Systemic psoriasis medications include methotrexate, which you can take as a pill, and new injected drugs called "biologics," such as Enbrel and Humira. Remicade another biologic, must be infused at the doctor's office.
By adjusting doses or medicine types, you may get more psoriasis relief in winter.
Psoriasis Tip 5: Check your Stress
"Stress plays a big part in making any skin condition worse," says Aldredge. The stress can be emotional or physical, such as having to have surgery. She tells patients: "Control the things you can. Take time to eat healthy, exercise, and do whatever you think is stress-reducing." She's had psoriasis patients tell her they reduce stress by prayer, singing in a group or exercising, among other options.
Most people who have lived with psoriasis for a long time are aware, Aldredge says, of the role stress in their lives plays in making the condition worse.
Psoriasis Tip 6: Consider Alternative Routes to Psoriasis Relief
Because stress can trigger or worsen psoriasis, the National Psoriasis Foundation suggests relaxation and stress-reduction techniques -- meditation and yoga in particular -- to help people manage their disease.
Few research studies have found proven benefit to alternative therapies for psoriasis, according to Abel and Aldredge, but that doesn't mean they wouldn't help you. Aldredge says some patients have told her that yoga, acupressure, and acupuncture all have helped relieve their psoriasis to an extent.
"If it works [for you], and it's legal and it's harmless, use it," says Aldredge.
But, remember, always discuss alternative approaches with your doctor first.
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Psoriasis: Treatment and Tips During the Holidays
’Tis the season for good cheer, good friends, good food … and, if you have psoriasis, a good chance that your skin condition will worsen.
Unfortunately, the holidays can be hard on psoriasis sufferers. Stress, cold weather, overindulgence, and winter viruses can make psoriasis symptoms worse. But the right psoriasis treatment and lifestyle tips can help.
The Link Between Psoriasis and Stress
There are some lucky souls who don’t find the holidays stressful. But, for the majority of people, the pressure to get everything done (the baking, the shopping, the office party, …) and keep everyone happy (is Aunt Sue still not speaking to Cousin Annie?) are notorious stress triggers.
“There are some patients, undoubtedly, in whom stress plays a role in worsening psoriasis,” says Mark Lebwohl, the chair of dermatology at the Mount Sinai School of Medicine of New York University. “Stress exists all year long, but it can be exacerbated for some people by the holidays in the winter.”
Evidence suggests that particularly stressful times may cause a psoriasis flare for the first time or worsen symptoms for some people who already suffer from the condition.
And, of course, having psoriasis itself can add to your stress level, between the physical discomfort of your skin lesions and concern about camouflaging your condition or handling people’s remarks or stares.
Ease Psoriasis Symptoms With Stress Reduction
The good news is that there are steps you can take (that don’t include hibernating through the holiday season), to control your stress levels, which may improve your psoriasis symptoms.
The medical establishment is increasingly accepting of stress-reduction therapies that may be beneficial components of your psoriasis treatment plan.
- For example, you may want to treat yourself to a massage or two (put a few sessions with a masseuse on your holiday wish list). The stimulation of your muscles may alleviate tension and also help minimize the pain of your psoriasis. If you have psoriatic arthritis, a painful condition experienced by 30% of people with psoriasis, massage therapy may also address some of the joint problems you experience.
- Other options to help ease psoriasis and stress include biofeedback, yoga, and meditation, all of which may offer you some much-needed relaxation and symptom relief.
Evidence suggests that mind-body techniques such as these are most effective when used in conjunction with conventional medical therapies, including topical or systemic medications.
For example, one study found that psoriasis patients who meditated during phototherapy, a procedure that uses ultraviolet light to address psoriasis skin lesions, healed faster than those who were treated with phototherapy alone
Psoriasis Holiday Tips: Be Moderate In Your Merriness
Perhaps you have a lot to toast this season with champagne, or maybe Uncle Eddie’s eggnog goes down really easily. Despite the temptation, it’s in your best interest to avoid going overboard with holiday indulgence.
Alcohol May Worsen Psoriasis
“Alcohol binges have been associated with a worsening of psoriasis,” Lebwohl tells WebMD. Additionally, alcohol may alter the effectiveness of certain medications used to treat psoriasis, so be sure to check with your doctor or pharmacist before you drink.
Cigarettes Trigger Psoriasis
If you tend to smoke when you drink alcohol, it’s important to recognize that cigarettes are a known psoriasis trigger. Studies have found that people who smoke tend to have more severe psoriasis than non-smokers, with people who smoke heavily faring worse than light smokers.
What About Foods and Psoriasis?
“Some people even say certain foods cause flares, though this hasn’t been proven scientifically,” says Melissa Magliocco, the acting chief of the Division of Clinical Pharmacology at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School. “But, by avoiding these foods, some patients say their symptoms improve a little bit.”
If you notice that certain foods or overeating tend to worsen your psoriasis symptom, ask your doctor about modifying your diet to see whether your skin condition improves.
(Keep in mind, psoriasis experts agree that it’s important to follow a healthy lifestyle year-round, including during the holiday season. Eating healthy foods and getting regular exercise will help keep your body in top shape and may make psoriasis treatments more effective.)
Taking care of yourself during the holiday season may also bolster your immune system, making it less likely you’ll catch a cold or the flu. Since psoriasis is an autoimmune condition, anything that dampens your immune system, such as a virus, can cause your skin condition to worsen as well.
Psoriasis Treatment Tips for Wintry Weather
When the weather outside is frightful, your psoriasis symptoms may worsen.
“Weather changes can be psoriasis triggers for some people, especially changes from warm to cold weather.
The cold, hard truth is that dry air and limited UV rays from the sun are psoriasis triggers for many people with the condition. Psoriasis experts say that ultraviolet light rays suppress skin cells that multiply too rapidly in patients with psoriasis.
- If you’re stuck in a wintry locale where your skin won’t see the sun for weeks or months on end, ask your doctor whether phototherapy might be right for you. This psoriasis treatment uses medically supervised exposure to UV light to treat psoriasis, either alone or in conjunction with certain medications.
- It’s also especially important for you to be diligent about moisturizing your skin during the winter months. Try using a gentle moisturizer daily after you shower to seal hydration into your skin.
- If you have certain areas where your psoriasis plaques are particularly troublesome, ask your doctor about occlusion. This technique consists of applying moisturizer to your skin, covering it with plastic wrap and leaving it on overnight. The plastic will intensify the effect of the moisturizing and in the morning you can gently exfoliate the area with a towel.
Keeping Warm and Camouflaging Psoriasis During the Holiday Season
If you and the kids are headed outside for a day of sledding, the right choice of clothing could make the day much more enjoyable.
- Even though wool might seem like a nice, warm option, many patients with psoriasis find that the texture of the fabric makes the itchiness of psoriasis more bothersome. Instead, try wearing layers of natural fabrics, such as silk or cotton, instead.
- If you have psoriasis on your scalp that is prone to flaking, wear lighter colored tops and scarves to help disguise any white flecks that do fall.
- If you can’t or don’t want to cover your psoriasis with clothing, there are cosmetic creams and cover-ups to help camouflage psoriasis. Though not foolproof, these creams can be applied to unbroken areas of skin and may minimize the appearance of psoriasis plaques and lesions.
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Dealing With the Stigma of Psoriasis
How can a person with psoriasis fight back against ignorance and prejudice?
When it comes to facing the stigma of psoriasis, there's one incident that sticks out in Robert Schwartz's mind: the time he was kicked out of a restaurant because of his condition.
After sitting down with a plate of food from a buffet, he remembers being approached by the restaurant manager and quizzed about his condition. "I tried to explain I was not contagious," says Schwartz, a Las Vegas man who has psoriasis on 75% of his body. He suggested that the manager could confirm it with any doctor.
But the manager was adamant. Schwartz could take food to-go, but he wasn't allowed to eat with everyone else. "I felt dejected," says Schwartz.
Schwartz has many other stories about the stigma of psoriasis -- being ordered by a casino employee to put on a long-sleeved shirt to cover his skin, being told he couldn't try on clothing at a store. Tragically, his experiences are not unusual. There are 7.5 million people in the U.S. with psoriasis. Many face similar humiliations day after day.
"I hear it all," says Mark Lebwohl, MD, chairman of the medical board of the National Psoriasis Foundation. "I hear about people with psoriasis being turned away from hairdressers, kicked out of swimming pools, and prevented from donating blood at blood banks."
The stigma of psoriasis can be crushing. But how can a person with psoriasis fight back against ignorance and prejudice? WebMD turned to some psoriasis experts to find out.
Living With Psoriasis
"The impact of psoriasis on a person's life is profound," says Robert Brodell, MD, a dermatologist at Northeastern Ohio Universities College of Medicine. "You're wearing the disease on the outside of your body." And even though it's not infectious, people tend to see the symptoms and connect them with whatever deadly diseases are making news. "People might assume it's HIV, or drug-resistant staph," says Brodell.
The stigma of psoriasis can quickly undermine the confidence of even the most self-assured. Well-meaning family members and friends may suggest you ignore how other people react. That's fine advice, but it's often not realistic. If someone flinches when you offer your hand, it's not something you forget. It's an experience that can radically change how you feel about yourself.
"People really can feel like lepers when they have psoriasis," says Alan Menter, MD, president of the International Psoriasis Council. "They're shunned."
The stigma of psoriasis can have a particularly destructive impact on a person's intimate relationships. "Psoriasis doesn't only show up on knees and elbows," says Brodell. "It can also appear on the genitals." Some people with psoriasis give up on dating altogether, rather than having to explain their condition.
Because of the stigma of psoriasis, many people keep it a secret if they can. "Psoriasis is a very hidden condition," says Menter. "It's amazing how often people will hide it for a lifetime from their families, even from their siblings or their children." They just wear long sleeves and long pants and never say a word.
While there are celebrities with psoriasis, Menter says, it's been almost impossible to coax them into speaking out about the condition. "They're afraid to let the public know that they have psoriasis because of the potential stigma," Menter tells WebMD. "So that's why you're not going to see a celebrity doing a telethon for psoriasis."
The Stigma of Psoriasis: Fighting Back
So what can be done about the stigma of psoriasis? Obviously, there's no easy answer. The problem with stigma is that it's fixed in the beliefs of other people. There's no way to single-handedly change them. But there are still some things that you can do.
- Learn about the condition. Become an expert. Having a better understanding of your condition not only helps you, but it makes it easier to explain it to others. It can also give you a sense of what to expect from social situations and how to prepare for them.
- Talk to your family and close friends. You're not obligated to tell anyone, of course. But you might find it helpful to have a core group who understands your condition. Keeping a secret, and living in constant fear of exposure, can add enormous stress. Besides, psoriasis can be a physically and emotionally debilitating condition. It's stressful to carry that alone. Knowing there are people who understand -- and who will help you when you need it -- means a lot.
- Educate others. It's not always easy, but some people combat the stigma of psoriasis with education. When they meet someone who doesn't understand, they explain what psoriasis is. They stress that it isn't contagious. For instance, Schwartz put up a video of himself talking about psoriasis on YouTube. He then handed out business cards to people with the web address on the back so they could learn about the condition.
Trying to educate people about psoriasis has several benefits. Obviously, it helps one more person understand. It reduces the world's ignorance just a bit. But it does more than that -- it gives you back some power. Psoriasis can make you feel helpless, like you're always being defined by other people's perceptions. By taking action and teaching others, you're defining yourself.
Still, there's no underestimating the difficulty of spreading the word about psoriasis to a suspicious and sometimes hostile audience. Sometimes, you'll feel like you're beating your head against a wall. And it's not realistic to expect that a person can cheerfully meet every instance of discrimination with a smile and education.
- Get support. Psoriasis is a condition that can drive people into isolation. Joining a support group is a great way to see that you aren't really alone. Try the National Psoriasis Foundation, which has self-help groups throughout the country. Seeing a qualified therapist is another way of getting some support.
Treatment for the Stigma of Psoriasis
Although it's indirect, there is another way of reducing the stigma of psoriasis: getting better treatment for the disease.
"The best solution to stigma is to clear the psoriasis,". "Clearing the skin is more effective than any other intervention. It improves a person's life by every measurement." Although you may be skeptical, the psoriasis treatments available now are vastly improved from what we had just a few years ago.
Brodell agrees, and urges people with psoriasis to stay optimistic. "Anyone with psoriasis has to have hope," he tells . "Psoriasis may be incurable, but in the vast majority of patients it is controllable. There are a lot of treatment options open."
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