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The Connection Between Psoriasis and Anxiety and Depression

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There’s one question that every doctor should ask someone with psoriasis, says Adnan NasirMD, Men’s Health advisor and a dermatologist in Raleigh, NC., and that’s: How is this affecting your life?

Because, as it turns out, psoriasis can have a great impact on both quality of life and mental health: About 30 to 35 percent of people with a skin disease see psychological repercussions such as anxiety or depression, says Mohammad JafferanyMD, a professor of psychodermatology, psychiatry, and behavioral sciences at Central Michigan University College of Medicine.

Dr. Jafferany specializes in psychodermatology — a relatively new specialty that focuses on the intersection between psychiatry and dermatology.

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The intersection between the two fields is complex.

On one hand, there’s a direct connection between stress and psoriasis flare-ups: Whenever you’re stressed, your body activates what’s called the hypothalamic-pituitary-adrenal (HPA) axis, which controls stress levels and hormones. People with psoriasis, he explains, have an altered HPA response to acute stress. There’s a link between higher cortisol levels and disease severity, he says.

On the other hand, dermatologic conditions like psoriasis are also psychologically impactful because they’re, well, there for everybody to see: Your skin might be red or scaly, raised or crusty, or weepy or bleeding.

“When people have something going on with their kidneys, nobody knows there’s a problem. With psoriasis, you’re wearing it on your body,” says Evan A. Rieder, MD, a dermatologist at NYU Langone. “People with psoriasis are very stigmatized by the general population.”

Psoriasis can wreak havoc on self-esteem, confidence, and relationships (psoriasis can involve the genitals), create feelings of stigmatization, and lead to isolation.

It’s a vicious cycle.

But it can be broken. These four expert-vetted strategies can help you feel better in your own skin.

Become a psoriasis expert

It would be great if everyone knew the ins and outs of psoriasis (farewell, stigma!). But unfortunately, that’s not the reality. So you might have to do a little bit of learning (and educating) yourself. It’s worth it; it goes a long way toward clearing up disease myths and helping keep flare-ups at bay.

Here’s an example: A common (and incorrect) fear about psoriasis is that it’s contagious. It’s not contagious. But if you think that it is, you might not want to touch your spouse or you might worry about spreading the disease to your kids. If you feel as though others think it’s contagious, it might seem like people are avoiding you or keeping their distance.

Educating yourself and others about the non-contagious nature of psoriasis means you’ll be more likely to keep up with your morning run club, weekend golf, or intimacy — all important pieces of mental health. It also helps those around you be there for you. All play a role in sinking stress and anxiety levels, thus potentially reducing flare-ups.

“Because of the visible nature of the disease, education — for patients, family, friends, and society — is very important,” says Dr. Jafferany.

talk it out

Psoriasis can breed isolation and feelings of loneliness. The downside to that? Many people who report serious loneliness also report feeling as if no one genuinely cares about them, according to a recent study by Making Caring Commona project of the Harvard Graduate School of Education.

But a social network is key in avoiding downward spirals and easing pain, that research found.

Having just one friend or having a spouse in whom you can confide can help you feel supported and spot troublesome mental health symptoms, like feeling trapped or hopeless.

Groups like the National Psoriasis Foundation also offer connections to others with psoriasis, host events like organized bike rides, and provide access to free apps like Twill Care that have specific support networks for psoriasis. “Connecting with different types of patients and exchanging ideas can help give people very good control over the condition,” says Dr. Jafferany.

a man talking to a psychologist or therapist

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Add to your medical team

Any time you notice a dip in mental health, seeing a psychologist or psychiatrist is a good idea. “Treatment should be a holistic approach — not just a dermatology treatment or just a psychiatric treatment, but a combination of things,” says Dr. Jafferany.

While it’s not a requirement to find someone who is versed in both mental health and skin conditions (any mental health treatment is better than no mental health treatment), a specialist can be particularly helpful. Problem is, they can be hard to find. Tea Association for Psychoneurocutaneous Medicine of North America (APMNA) — an organization of dermatologists, psychiatrists, psychologists, and other health professionals — offers a small provider directory. Your dermatologist may also know of mental health colleagues who have an interest in dermatology.

Rethink your meds

Medications such as biologics — newer injectable medicines that target the specific areas of the immune system that are impacted by psoriasis — could actually help with depression. One 2018 study in The Journal of the American Academy of Dermatology found that biologics reduced the risk for depressive symptoms, whereas phototherapy (light therapy used to treat psoriasis) did not. A dampening down of inflammation could have positive impacts on both psoriasis and depression. Biologics are also simply highly effective at treating psoriasis. “People’s quality of life improves when their psoriasis improves,” says Dr. Rieder.

Commonly prescribed antidepressants called selective serotonin reuptake inhibitors (SSRIs), which directly help with depression can also indirectly help with well-being, quality of life, stress levels, and in turn, flare-ups. “It’s all interconnected,” says Dr. Jafferany.

Talk to your doctor about your course of treatment if you’re experiencing psychological side effects.

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