When people talk about psoriasis, the focus tends to be on the condition’s physical manifestations. But given that psoriasis is often a highly visible condition, it shouldn’t come as any surprise that its effects are more than skin-deep. Psoriasis impacts people psychologically and emotionally too, especially when it comes to intimacy. Some people with psoriasis are nervous about holding hands with a new partner, and others shy away from relationships completely. Many worry about how others will perceive them. All of this can wreak havoc when it comes to relationships.
To learn more about how psoriasis can impact someone’s love life and intimacy, we reached out to two women with psoriasis and a few dermatologists who treat the condition. The takeaway: If psoriasis is greatly affecting your self-image, relationships, and overall comfort with partners, other people can relate—and help is out there.
Psoriasis is an inflammatory condition that may affect the skin, scalp, nails, and joints, Shari Lipner, M.D., a dermatologist at Weill Cornell Medicine and NewYork-Presbyterian, tells SELF.
There are multiple types of psoriasis, but the most common is a kind called plaque psoriasis, the Mayo Clinic says. In this form of the disease, inflammation can lead to discolored and itchy raised lesions (called plaques) and scales that appear on the skin. This happens when a person’s overactive immune system speeds the growth of skin cells, according to the Mayo Clinic.
Typically, plaque psoriasis appears on body parts like the elbows, knees, legs, lower back, and scalp. For some, the condition affects only a small part of the body, but it can also be more widespread and severe. Contrary to common misconceptions, this condition is in no way contagious. Instead, many people who develop psoriasis are genetically predisposed to it, then an environmental trigger (such as stress, weather, or a skin infection) sets off symptoms, the Mayo Clinic explains.
Psoriasis symptoms can pop up at any age, but for many people it first appears in adolescence or early adulthood—right around the time people are often starting to dip a toe into romantic and physical relationships. The condition is chronic, which means people will have it long-term, but it tends to wax and wane in severity.
“There are periods of time when the skin may be clear, and there are periods of time when the skin may be covered” with plaques, Evan Rieder, M.D., an assistant professor of dermatology at NYU Langone Health who is board-certified in dermatology and psychiatry, tells SELF. As many people with psoriasis know all too well, these symptom flares can be devastating to self-esteem and make it a struggle to connect with people romantically—or even find oneself worthy of the chance to do so.
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For some people, living with a highly visible skin condition can do a number on self-esteem. “Psoriasis is often a source of embarrassment or shame, and in some cases, psoriasis is associated with depression,” Joshua Zeichner, M.D., an associate professor of dermatology and director of cosmetic and clinical research in dermatology at Mount Sinai Hospital, tells SELF. It can also be associated with other mental health conditions, like anxiety. “The appearance of the skin may stand in the way of wearing certain types of clothing and even participating in activities that patients would otherwise be interested in.”
Dr. Zeichner says there are ways to camouflage psoriasis, but some people may have a hard time developing new relationships and exposing their skin to new partners.
“I’m extremely conscious of my skin condition, and this has prevented me from going on many dates,” Mollie Newton, a 36-year-old with psoriasis, tells SELF. “I’ve become afraid of instant judgment because some of the patches and rashes I have are in visible areas. What’s even more demeaning is that sometimes I get disgusted looks when I tell [potential partners] about it.”
When psoriasis affects self-image, it can also get in the way of physical intimacy. Some people fear a negative reaction from others, and may not want to hold hands or show their skin in areas where their psoriasis is visible. Some avoid relationships, especially if they have received negative reactions to their condition in the past and are afraid it will happen again.
A big problem here is that a lot of people aren’t very familiar with psoriasis and may incorrectly assume it’s contagious when they see the differently colored and scaly patches on someone’s skin. “It is not infectious or contagious, but not everyone knows that and people may fear getting close to someone with psoriasis,” Dr. Lipner says.
Newton says it’s hard to enter relationships, particularly with people who aren’t educated about psoriasis and worry that it’s contagious. “This has seriously affected my confidence,” Newton says. Sometimes when people see her skin, they move away so they won’t touch her. She says she’s developed a habit of being the one who moves away “just so I don’t offend them.”
The impact psoriasis has on self-image and relationships can be especially severe with a form of the condition called inverse psoriasis, which commonly develops within skin folds in the armpits, groin, genitals, and other parts of the body. People with inverse psoriasis may feel like they can’t be intimate with their partners, or it may impede them while dating because they feel so self-conscious about their skin, Dr. Rieder says.
Of course, these issues can arise when psoriasis affects other parts of the body too.
Michelle Soo In Lee, who is a 22-year-old with psoriasis, says it took a long time for her to be able to really embrace being naked—both in front of herself or with a partner. “If I couldn’t love my own body, how could anyone else?” she says.
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Touch can be uncomfortable for Lee too. Her boyfriend loves to show affection by placing his hands on her thigh when driving, she says, but she also notes that was really tough for her to handle at first. “I’d start getting nervous and slowly shifting his hand away because I didn’t want him to feel the flakes,” she says. “I think I hurt him that way, because I often rejected his little affirmations of love.”
There’s no denying that psoriasis can be extremely challenging to live with, especially if it makes you feel undesirable or leads you to shy away from intimacy. Fortunately, psoriasis treatment can help reduce its impact on self-esteem and relationships. Medical experts like dermatologists can offer treatments to better manage symptoms from psoriasis and the impact the disease can have on a person’s self-image.
Common treatment options include biologics, which modify the immune system to calm the inflammation involved with psoriasis, topical drugs to actively target symptoms, and more, according to the Mayo Clinic.
“We can get people feeling much more confident in their own skin and able to go about their social, their romantic, and their occupational life at a very high level,” Dr. Rieder says.
Therapy can help too. If you’ve worked with a dermatologist to bring your psoriasis under control but you’re still feeling anxious, depressed, or nervous about intimacy, seeing a mental health provider may be a useful next step to help you become more confident in your self-worth. “It’s a gift you can give yourself,” Dr. Rieder says.
