Doctors Say Psoriasis Treatments Should Include Mental Health
For the eight million Americans living with psoriasis, the mental impact can be as great as the physical one. A dermatologist and psychologist weigh in on why treatment must address both burdens.
This story originally appeared in the August 2020 issue of Allure. Learn how to subscribe here.
THE PHYSICAL SIGNS OF PSORIASIS
By Joel Gelfand, a professor of dermatology and epidemiology at the University of Pennsylvania Perelman School of Medicine and director of the school’s Psoriasis and Phototherapy Treatment Center.
I worked on a survey that found 30-40 percent of people in the United States think psoriasis is contagious — they don’t want to shake the hand of someone with psoriasis. Think about that. If one in every three people that you run into on the street is going to have that view of your skin, that’s a really challenging thing to cope with. Psoriasis can be socially isolating and cause people to feel anxious and depressed.
Psoriasis is not contagious. It’s a common autoimmune disease of the skin, in which your body recognizes a normal skin protein as abnormal and tries to get rid of it by making skin flake off. This results in large, thick, scaly plaques that crack and bleed, and can be painful and itchy. The areas it impacts can vary, but some of the most sensitive are the scalp, face, genitals, and fingernails. A lot of patients won’t wear short sleeves or shorts because their knees or elbows are affected. The typical onset is in young adulthood, but I’ve seen it in infants all the way up to a patient in her 80s, who experienced it for the first time after her sister died. Studies have shown that people facing major life events are at higher risk of developing psoriasis, and that patients with psoriasis report higher levels of stress. There’s a cyclical relationship.
As tough a disease as psoriasis is, we do have a variety of ways of treating it. It can take weeks or months to see results. When the disease is localized, people like topical medications, which decrease the growth of excess skin cells [that make up psoriasis plaques]. But they may not work for some patients, and they’re inconvenient, especially if a lot of areas are affected. Pills can reduce the overactive immune response, but some can prompt gastrointestinal symptoms. Injectable medications, called biologics, are highly effective but expensive, and can make people slightly more prone to infection because they decrease immune activity in the body. My lab is researching at-home UV phototherapy, which would be more widely available than office-based ones.
But when a patient has significant psoriasis, I know there’s more going on than what I can see. They are more prone to diabetes and cardiovascular disease, and have increased mortality risk, so we make a plan to address all aspects of the disease. I’m also thinking about their emotional well-being. When some patients are stressed their psoriasis gets worse, so we work on stress management. There’s even been research showing that mindfulness techniques like meditation can make people more responsive to psoriasis therapies.
THE MENTAL SIDE EFFECTS OF PSORIASIS
By Kristina Gorbatenko-Roth, a professor of psychology at the University of Wisconsin-Stout.
One of the mental health challenges with skin conditions is that they’re observable illnesses. People may stare, and that can make a patient feel stigmatized. Some patients may expect people to react negatively, so they might decide they’re not going to go out, or they can’t go swimming.
The amount of distress is often but not always connected to how objectively severe psoriasis is. A relatively new area of research in dermatology hypothesizes that if you had really bad psoriasis at a young age and were socially isolated, it can impact your social life later on, even if your skin improves.
If we could help a patient manage stress and correctly interpret the social interactions they’re dealing with because of their skin, hypothetically they may have more mental energy to follow their treatment plan — which can often be very involved and difficult — which could, in turn, lead to a better chance of improving their condition. Giving a patient empathy and space to talk about their skin condition and how it has impacted their life makes them feel validated.
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