Stigma stemming from misconceptions about psoriasis, embarrassment over skin appearance, and lack of public awareness can keep people with psoriasis from seeking the treatment they need.

Psoriasis is one of the most common skin conditions in the world. Yet myths — such as those suggesting that psoriasis is contagious or related to personal hygiene — persist.

People with psoriasis report being asked to leave gyms, pools, and even their jobs due to the stigma attached to the disease.

Overhearing rude comments, being stared at, and feeling excluded can take a toll on a person’s mental health. For some, psychological and social problems become more challenging than the physical symptoms of psoriasis.

In this article, two board certified dermatologists provide insights into the stigma around psoriasis and how it can affect treatment. They also recommend steps to end the stigma.

Stigma is about the perception of being different from everybody else. It can involve feelings of humiliation and fear of social rejection, as well as actual social rejection.

“When a patient is living with a chronic skin disease like psoriasis — one that can show up on areas like the face, neck, and hands — that’s a tough thing to get comfortable with. And it can interfere with day-to-day life,” said Dr. Mona Gohara, a dermatologist in Hamden, Connecticut, and an associate clinical professor of dermatology at Yale School of Medicine.

People who see psoriasis lesions on others but do not understand the disease may become uncomfortable. They may be afraid that they might catch the disease, or they may view the person as “unclean.”

Recent research suggests that visible lesions are the most stigmatizing. But lesions on the buttocks and in the genital area can contribute to feelings of stigmatization in intimate relationships as well.

Dr. Emily Wood, a dermatologist at Westlake Dermatology in Austin, Texas, explained that people may feel embarrassed to expose their affected skin.

“Patients often feel they want to wear long sleeves and pants to cover their disease. It can also be very embarrassing for patients to have skin flakes show up on their clothing. It can definitely be more difficult to have psoriasis as a kid, due to being around peers who do not understand your disease process,” said Wood.

Gohara has seen patients avoid social interactions and begin to experience anxiety, depression, and body image issues as a result. She noted that this can be isolating and highlighted a strong link between skin health and mental health.

She went on to state that people of color may face a tougher reality when it comes to diagnosis and treatment.

“Clinical and therapeutic data about psoriasis in non-Caucasian racial groups is currently limited, which can present diagnostic challenges,” said Gohara.

This can worsen the mental health effects and cause more stress, she explained. “And stress is a common psoriasis trigger, so this can feel like an endless loop.”

Stigma can lead to symptoms of anxiety and depression. In addition, a 2017 study on the psychological burden of psoriasis suggests that social stigma is a more significant factor in depressive symptoms than the physical symptoms of the disease.

“Differences in the way psoriasis presents in patients can also, unfortunately, lead to delays or misdiagnoses for patients of color,” said Gohara.

While psoriasis causes thick, red plaques on lighter skin tones, the plaques can appear more gray or purple on darker skin tones, she explained.

When it comes to delays in treatment, Gohara noted that it is important to acknowledge the overlap between skin health and mental health.

“From my experience, sometimes it’s obvious that a patient is struggling with the mental challenges of living with a skin disease but isn’t being forthcoming about their full experience,” said Gohara.

Wood agreed. “Many patients feel psoriasis may be related to poor hygiene, especially when it affects the groin or scalp. In fact, these areas are classic locations for psoriasis.” Wood said she often finds that her patients do not even bring up that they have psoriasis in the groin area or on the scalp unless she specifically asks.

Feelings of distress can cause a person to lose hope and feel out of control, and this can potentially affect their response to therapy, according to a 2021 review that examined stigmatization in people with psoriasis.

Wood stressed the need for public education about psoriasis, highlighting the common misconception that psoriasis is due to something within a person’s control.

“Quite the opposite is true. Psoriasis is impacted by genetics, environment, and the immune system,” she said, noting that none of these factors are within a person’s control.

Wood referenced Kim Kardashian, who has recently brought more awareness to the condition by speaking openly about her experience with psoriasis. “I think it is incredibly helpful when celebrities or public figures speak out about their own experiences with psoriasis. In a way, it normalizes having the disease,” explained Wood.

Gohara said it is important for doctors to speak with their patients about the full impact of the disease to help them feel comfortable and open to asking for help. She added that it can help determine how to adjust treatment and manage successful outcomes.

“The biggest thing that needs to happen is letting patients know that they are not alone,” said Gohara. “Positive social connections and lower levels of inflammation are related. That means fostering a strong support network can indirectly benefit individuals living with skin disease.”

Stigma related to psoriasis can cause a person to delay seeking treatment. The related stress can worsen symptoms and have a negative impact on mental health.

Experts cite public education, open communication between doctors and patients, and strong support networks as keys to overcoming psoriasis-related stigma.