How to Say No to Psoriasis Shame and Embarrassment

Still, many people with psoriasis feel shame or embarrassment about their condition, especially if it’s easily visible to others. There can be many dimensions to these feelings, including fear of social isolation, rejection by potential romantic partners, and harmful consequences to your career.

Here’s what you should know about shame related to psoriasis, including how it can affect your life, what you can do about it, and when it may be time to seek help.

Many people with visible signs of psoriasis report feeling embarrassment or discomfort in public or social situations.

Visible lesions on exposed areas like your hands and face, as well as genital involvement, are strongly associated with stigmatization and the fear of being singled out, says Soo Jung Kim, MD, PhD, an associate professor of dermatology at the University of Washington School of Medicine in Bellevue.

Dr. Kim adds that women and people with workplace interactions in which their psoriasis is visible often have the greatest psychological burden. Emotional responses can include not only shame and embarrassment but also low self-esteem, sadness, and anger.

It’s important, Kim says, to distinguish between other people’s reactions to your psoriasis, such as making rude or ignorant comments, and your own internal reactions, such as feeling dirty or unlovable. In many cases, she says, your internal reaction may be greater than anything you experience from others.

Factors that can affect both how others treat you and your feelings include these issues:

• Amount of Redness or Scaling More visible psoriasis can invite both scrutiny from others and internal distress, says Jennifer Yeh, MD, PhD, a clinical assistant professor of dermatology at the Stanford University School of Medicine in Redwood City, California.
• Workplace Visibility “For individuals in public-facing roles,” Dr. Yeh says, visible signs of psoriasis “can be particularly distressing and may influence career decisions or advancement opportunities.”
• Location of Psoriasis Visible symptoms on your face, hands, or arms often cause the most distress. What’s more, “scalp involvement may result in prominent flaking that can be mistaken for dandruff and may influence clothing choices,” says Yeh.
• Dating or Relationship Concerns “Patients may fear rejection or misunderstanding from romantic partners, even when partners are supportive,” says Yeh. That’s particularly true for some people with inverse psoriasis, which often affects the armpits and genital or groin area.

Of course, how badly others react to your psoriasis can have a large impact on your emotions. “I’ve heard a number of stories that patients have shared with me about shaming or bullying,” including being asked to leave a restaurant to avoid attracting attention, says Lauren Taglia, MD, PhD, a dermatologist at Northwestern Medicine in Geneva, Illinois.

While having active psoriasis isn’t anything to be ashamed of, many people find that getting effective treatment for their psoriasis is an important way to help reduce any emotional impact. Here are some other strategies to consider.

Optimize your psoriasis treatment. “Meaningful skin clearance improves quality of life and reduces depression and anxiety,” says Kim. Biologic drugs have transformed psoriasis in this regard, she says, making skin clearance a realistic goal for many people. “Advocating for effective treatment is both dermatologic and psychological care,” Kim says.

Have a script. In some situations, you may want to have a speech ready to explain your psoriasis to anyone who may treat it with suspicion, such as a hairdresser, gym goer, or coworker. “Helping individuals understand psoriasis as a chronic inflammatory skin condition, rather than a contagious infection, can meaningfully reduce shame,” says Yeh.

Choose comfortable clothing. Your clothing choices can affect your confidence when you have psoriasis. It’s usually a good idea to wear loose-fitting, comfortable clothing, and you can also choose colors or patterns that help hide or distract from any skin flakes or visible areas of affected skin. What’s more, “wearing loose-fitting clothing made of soft breathable fabrics can reduce the risk of new lesion development,” Yeh says, since skin friction or irritation can contribute to this process.

Practice self-care. Activities that boost your overall confidence can be beneficial even if they’re not directly related to psoriasis. You might want to try these ideas:

• Recreational sports and activities like walking, hiking, pickleball, and team sports
• Mind-calming practices like yoga, meditation, and journaling
• Avoiding social media feeds that make you feel bad about your body
• Spending time with people who accept you and understand your psoriasis

If the emotional toll of living with psoriasis feels overwhelming, you may want to seek out psychotherapy (talk therapy). Several forms of this therapy exist, which can be done in person or through an online platform.

“Even patients with more mild disease can experience a mental burden that’s debilitating,” says Dr. Taglia. In that case, she says, “we try to have a collaborative approach with other specialties,” particularly mental health professionals.

If you’re interested, ask your doctor about a referral to a mental health specialist with experience helping people reduce the emotional toll of skin conditions. You can also look at telehealth options through your health insurance provider, which may include mental health specialists.

Types of talk therapy that could help include the following:

• Cognitive Behavioral Therapy This type of therapy helps you become aware of, and change, thinking patterns that may be creating problems for you.

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• Mindfulness-Based Cognitive Therapy This therapy combines elements of cognitive behavioral therapy with mindfulness practices, such as meditation, that can help you understand your thought processes.

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• Acceptance and Commitment Therapy This therapy helps you acknowledge and accept your thoughts and emotions, which can lead to less negative thinking and behavioral changes.

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• Habit Reversal Training This therapy helps you stop an unwanted behavior like scratching by replacing it with other behaviors.

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Above all, don’t hesitate to seek help for shame or distress related to psoriasis. “It’s a big part of the condition,” says Taglia. “It’s more than just the skin.”

• The emotional burden of psoriasis can be as significant as the physical symptoms.
• Advocating for effective medical treatments to clear your skin, preparing a script to explain the condition to others, and connecting with peer support groups can help reduce feelings of shame or embarrassment.
• If the emotional toll of living with psoriasis feels overwhelming or debilitating, talk to your doctor about a referral to a mental health specialist.