The visibility of psoriasis and misconceptions about the skin condition can cause social stigmatization and discrimination. Psoriasis is an autoimmune condition characterized by raised plaques on the skin. Disease severity varies by person, but plaques can be red or purple, flaky, itchy, and they may even bleed.
The origins of psoriasis date back to ancient Greece, but the distinct identification of psoriasis did not occur until the 19th century. During ancient times, psoriasis, leprosy, and other skin disorders were thought to be the same condition. There were different beliefs about the cause of psoriasis, like blood disorders, allergies, or poor hygiene.
People with leprosy or psoriasis were often shunned by society, namely due to the visibility and assumed contagiousness of their skin lesions. In some cultures, people with these skin conditions were required to carry around a bell to announce their presence and wear special clothing to distinguish themselves in public spaces.
In 1809, a British physician named Dr. Robert Willan distinguished psoriasis from other, similar skin disorders. Then, in the 1830s and 1840s, a French dermatologist named Camille Melchior Gibert — and later a Austrian dermatologist named Ferdinand von Hebra — classified psoriasis as a condition separate from leprosy. The distinction of psoriasis as a distinct condition helped to ensure that people with the condition were accurately diagnosed, and led to improved therapies to treat it.
While the understanding of psoriasis, and thus the social acceptance of it, has improved over time, there is still social stigma related to the dermatological condition. Psoriasis is a common skin disease, with over 8 million cases in the U.S. However, there is still widespread misunderstanding about the condition.
A study conducted in 2018 with about 200 laypeople and a similar number of medical students in the U.S. discovered roughly one-third of participants had negative attitudes toward people with psoriasis. Participants in the study reported stigmatizing beliefs about avoiding people with the psoriasis, including not wanting to date or shake hands with them, or invite them into their homes. This study highlighted the need for more awareness and education around psoriasis.
A study published in the Journal of the American Academy of Dermatology noted that people with psoriasis, as compared to other skin conditions, may experience higher levels of stigmatization. Many people in the study who did not have psoriasis had misconceptions about the condition, thinking that psoriasis was infectious and contagious.
Members of MyPsoriasisTeam share how they’re sometimes perceived as contagious. One member with scalp psoriasis wrote, “A little girl came up to me and asked if I was contagious.” Another member commented, “Most people think that it's contagious and back away from me, even after I tell them that it is not contagious.”
Many members worry that others perceive their psoriasis as contagious, even if they don’t make a comment. “The psoriasis on my elbows is so embarrassing,” one person wrote. “I also think people are looking at me funny or are thinking it's contagious.” Another member noted, “I always tried to hide my condition, and was afraid that other people would think it is contagious.”
“I don't know which is worse — the physical or the mental part,” explained one MyPsoriasisTeam member. “The pain, the stigma, the shame. It takes its toll on you.” Social stigma related to psoriasis can negatively affect every aspect of a person’s life, including their mental health, social interactions, and physical health.
Stigmatization toward people with psoriasis may impact their daily lives and well-being. A survey by the National Psoriasis Foundation found that over 75 percent of people with psoriasis felt that the condition had a moderate to large negative effect on their quality of life. Research has shown that people with psoriasis may experience reductions in quality of life comparable to those found in people with illnesses like cancer and heart disease.
Social stigma due to psoriasis can also have negative consequences on mental health. A small study on people with psoriasis in Iran found that social stigma due to psoriasis was associated with a lack of social support, unrealistic and inappropriate labeling (being labeled as a “bad” or “infected” person), rejection, and isolation. Participants reported feelings like discrimination, hatred, and humiliation, and experienced rejection by others.
Psoriasis may cause a type of stigma called self-stigma or internalized stigma. Self-stigma is a process through which one feels low self-esteem and feelings like shame or hopelessness due to a disease-related trait that is not socially accepted. Social and self-stigma may coexist, and can produce feelings like guilt and fear of being judged by others.
Psoriasis and the resulting stigmatization may also affect feelings of stress. A study found that stress resulting from anticipating others’ reactions to psoriasis contributed more to people’s feelings of disability in their daily lives than other mental and physical health factors. Since stress can make symptoms of psoriasis worse, feelings of stress due to stigmatization from psoriasis could, in turn, cause a new flare-up or worsening of symptoms, and create a troubling cycle.
The visible nature of psoriasis and fear of stigma may cause feelings of embarrassment in situations requiring exposed skin, like swimming or intimate relationships. People with psoriasis may have fears and feelings of being misunderstood by others and their physicians. Psoriasis may also have an effect on social life, and create social difficulties and tension with family members.
A MyPsoriasisTeam member commented about the difficulties in dealing with social stigma from psoriasis: “When dealing with something like psoriasis, it has a large impact on your mind and body. The physical pain and suffering alone is debilitating, but throw in the social aspect and stigma, and you get hurt on a whole new level.”
Stigma from psoriasis may influence other health conditions and comorbidities. Research has shown that people with psoriasis already experience more depressive symptoms than those in the general population. A study found that people with psoriasis who felt stigmatized in social situations showed even more depressive symptoms than people with psoriasis who did not feel that stigmatized.
Some people with psoriasis choose to address the social stigma by educating the people around them about psoriasis. “Psoriasis has a stigma, and people who don't have it don't understand how it works. I used to be ashamed of my psoriasis, but now I teach them about it and try to break the stigma. That's all we can do,” said one MyPsoriasisTeam member. Another said, “I think the more information and real-life stories that are available, the better.”
While teaching others about psoriasis works for these MyPsoriasisTeam members, it is a personal choice, and you are not obligated to educate others about your health condition.
It’s important to seek counseling or therapy if the social stigma of psoriasis is negatively affecting your quality of life. Speaking with a trained professional may help you to feel like you can better cope with feelings of stigmatization and isolation from the condition. Your dermatologist or primary care provider may be able to provide a referral.
Find health care providers and dermatologists who are empathetic and understanding. Establishing a solid bond with the physician who is treating your psoriasis could help you to feel more understood and in control of your psoriasis. It may also help with negative feelings due to social stigma. Tell your physician if you experience negative mental health effects related to psoriasis stigma. They may provide you with additional support and resources in addition to the treatment of psoriasis.
Establishing and building social support is a great way to combat the negative emotions brought on by social stigma due to psoriasis. Speaking with other people who have similar experiences can help you to feel less alone and more understood in your life with psoriasis.
Joining a psoriasis support group, whether in-person or virtual, can help to improve your quality of life. MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 92,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.
Are you living with psoriasis and social stigma? Share your experience in the comments below, or start a conversation by posting on your Activities page.