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How to manage the mental health fall out of psoriasis

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Catriona Williams

Chief Executive talkhealth Partnership

Psoriasis affects around 2% of the British population, meaning that over a million of us live with scaly, itching patches of skin. So, why isn’t the mental health fall out of the condition discussed more openly?

What do Kim Kardashian, Cyndi Lauper and Art Garfunkel all have in common? Psoriasis.

According to NICE (the National Institute for Health and Care Excellence), up to 2.2% of Brits have the condition. That means that over a million people deal with dry, red, plaque-covered patches of skin. 

Types of psoriasis

There are four types of psoriasis. The way people may go about managing and thinking about their skin may depend on which type they have:

  • Chronic (long-term) plaque psoriasis: the most common type of the condition. Plaques (scales) cover the knees, elbows, trunk and scalp.
  • Guttate psoriasis: often develops after a streptococcal throat infection and is more common in teenagers and children. Symptoms include small, drop-shaped sores on the chest, arms, legs and scalp.
  • Palmoplantar psoriasis: affects mainly the hands and feet.
  • Pustular psoriasis: a rare type of psoriasis that causes pus-filled blisters.

Having a dry skin condition can take a huge toll on your mental health. If you’ve got palmoplantar psoriasis, for example, you might feel uncomfortable shaking hands or touching public surfaces, while chronic plaque may make wearing shorts or skirts a real body confidence battle. 

Skin is our biggest organ, so it’s no wonder that when it’s not feeling or looking its best, we see our mental health start to deteriorate.

Mind versus skin

Back in April, talkhealth teamed up with the British Skin Foundation to host an online clinic on mental health and skin.

We found that so many of our members were either struggling with their mental health because of their skin issues or that their mental health was triggering debilitating symptoms.

Steve* lived with a generalised anxiety disorder, which he said was making his psoriasis worse. What could he do, he asked, to better manage both? 

Consultant dermatologist, Dr Alia Ahmed, said that the link between psoriasis and psychological health is well known, but it’s hard to say if one causes the other; it’s a chicken-egg scenario.

However, “we do know that treatment of both the mind and skin together generally leads to better outcomes,” she explained. 

“People with psoriasis do tend to have higher levels of anxiety and depression than those without skin conditions. I would suggest seeing a psychodermatology service to address both issues concurrently.

This may include better medical treatment of your skin coupled with psychological interventions or anxiety-reducing medications.”

Tools for tackling the itch

Another member said that her psoriasis had got worse during lockdown, something registered clinical and health psychologist, Dr Andrew Thompson, said was only to be expected.

As well as recommending mindfulness practice, physical exercise and staying in touch with friends and family, he suggested trying an approach called ‘habit-reversal’ to break the itch-scratch cycle. 

Habit-reversal involves monitoring your itch using a clicker or tally counter, before looking to substitute scratching behaviour with an alternative response. More information can be found on habit reversal at www.skinsupport.org.uk.

Skin is our biggest organ, so it’s no wonder that when it’s not feeling or looking its best, we see our mental health start to deteriorate.

With increasing attention being paid to mental health, we need to start seeing more emphasis on the link between common mood disorders and skin issues – particularly psoriasis.

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