Recreational activities, relationships and everyday life with psoriasis

Photo of two men chatting (Radnatt / iStock / Thinkstock) Living with psoriasis isn't always easy. But there are various ways to deal with the challenges in everyday life and the emotional effects. It's important to stay positive and not let your own wellbeing be determined solely by the appearance of your skin.

Although psoriasis isn't a dangerous disease, it can be very distressing: The intensive skin care regimen, many time-consuming treatments and the sometimes agonizing itching can all have a major effect on quality of life. But people with psoriasis don't only have to learn to deal with the symptoms of the disease. They are also often confronted with others' prejudices because psoriasis can be so clearly visible, especially during flare-ups. This can lead to problems in all of the main areas of your life – in romantic relationships, during recreational activities, at school or at work. In some people, psoriasis has such an effect on their emotional wellbeing that they develop depression or other mental health problems. But many people develop their own strategies to cope with it over time.

Appearance and wellbeing

People with psoriasis often spend a lot of time and effort hiding the condition from others. This is especially true of teenagers and young adults, for whom appearance tends to play an especially important role. But it is often difficult to cover up the affected areas of skin, particularly if they are on your neck, head or hands. Doing so can take a lot of time and make it hard to be spontaneous.

Psoriasis on the hands or nails can be very unpleasant for women in particular. It can also be a problem for people who have a job that involves dealing a lot with customers. People whose nails are affected are often afraid of seeming unattractive or poorly groomed. Nail polish can be used to cover up discolored areas.

If people are embarrassed or afraid that others might feel disgusted by their abnormal-looking skin, they may avoid normal recreational activities and sports with close physical contact or sports like swimming. Some people have such severe psoriasis that they even avoid looking at themselves in the mirror.

When out in public, people with psoriasis deal with the condition in different ways: Most of them don't want others to see their psoriasis, and conceal it with a foundation or clothing that helps to cover it up. Some people are open about their condition because they don't feel the need to hide it or they think that doing so is too much of a hassle.

But the way people feel about their psoriasis often changes over time: Often it's difficult to accept the diagnosis at first. Many don't want to believe it for a long time, which costs them a lot of energy. People who have had psoriasis for some time and have come to terms with it say that, looking back, it would have been better to accept the disease as part of their own body earlier on. Sharing your experiences and feelings with others – in a self-help group, for example – can help with this process.

Relationships and sexuality

Many people with a skin condition have a hard time approaching others. They feel unattractive and worry about being rejected. Some don't even dare to strike up a conversation, while others are afraid of starting a relationship or allowing more intimate contact. Sometimes the first step in changing that is to learn to accept yourself – regardless of what your skin looks like at the moment.

People who have psoriasis are often the harshest critics of their own body, which makes everyday life that much more difficult. It is important to develop a positive attitude and recognize that there are also a lot of people who don't have a skin condition but are still not satisfied with their body for various reasons, and who feel insecure as a result. It is good to know that many people with psoriasis have found a partner who accepts them as they are.

It can be helpful to talk frankly about your psoriasis before becoming intimate with someone. Doing so may help you to relax and avoid misunderstandings. Also, the other person is then prepared and can better understand the disease and its effects.

Psoriasis in the genital area can make sex painful. It's also best to speak openly with your partner about this. Using a lubricant or condom is one possible solution. Oil-based lubricants like Vaseline or oils can attack the latex in condoms though, making them less reliable as a form of protection. So water-based lubricants are more suitable. It should be clear from the product package whether or not it can be used with a condom.

If a woman uses a cream or ointment for the treatment of psoriasis in the genital area, care should be taken to prevent it from getting into her vagina during sex.

Many people with psoriasis lack the energy for sex during a flare-up, or they don't feel like it. Close physical contact and tenderness do remain important and pleasant for most of them, though. This can help couples to still feel intimate and close even in phases without sex.

Dealing with other people's reactions

People with psoriasis are sometimes stared at by others. This is usually not done to be mean – instead, it is more likely that the person has never seen psoriasis before and doesn't know anything about it. Some people may also be worried that the psoriasis could be contagious, although it isn't.

Most of us have at some point taken a longer look at someone because something about them is "different": Perhaps their clothing or hair, the color of their skin or a physical disability. It can help to remember that when people stare it is often simply out of curiosity, surprise or ignorance.

There is no one answer to the question of how to best deal with such reactions from other people. There are very different ways of going about it: Maintaining direct eye contact with the other person is sometimes enough to signal in a friendly way that you have noticed their glances. That may make them aware of their behavior and they might stop looking at you.

But it may also be appropriate to tell the person directly that you would prefer not to be stared at. Gathering up the courage to address them may help you to relax and reduce your own annoyance or embarrassment. It might be good to come up with a few things to say in those situations before they arise, so you don't feel at a loss for words. For instance:

  • I'd rather you didn't stare at me like that.
  • There's no need to be scared of me. This is psoriasis, and it's not contagious.

Some people might even ask you about it themselves. Then offering a simple explanation is often enough. For instance: "I have a chronic skin condition called psoriasis. My skin cells multiply much faster than normal. It isn't contagious, though."

Dealing with other people's reactions can get on your nerves – and whether or not you want to respond to them will also depend on how you're feeling at the time. Some days it might be easiest to just ignore the looks and comments or walk away.

If there are certain people who you keep on running into, like at work or school, it often helps just to explain the disease to them. That can help you to gain control of the situation. Also, you'll probably feel relieved once the "psoriasis issue" has been talked about.

Dealing with emotional stress

Everyday and emotional stress can trigger and worsen flare-ups of psoriasis. There are different ways to deal with stress. Some people find relaxation techniques like autogenic training or Jacobson's progressive muscle relaxation helpful, while others do sports and let off steam that way, or pursue hobbies that help them to switch off.

Psoriasis is so distressing for some that they develop mental health problems such as depression, anxiety disorders or even addictions. For example, worrying about being rejected by others may result in someone becoming withdrawn, no longer going out or not doing sports. Not doing activities that you actually enjoy and isolating yourself can lead to depression or to alcohol or drug abuse.

Certain thought patterns sometimes make depression more likely. Some examples include:

  • Overgeneralization: This is generalizing based on just a few experiences – for example, concluding that it's impossible to find a hairdresser who isn't bothered by your psoriasis because one hairdresser reacted negatively.
  • Personalization: You see yourself or the psoriasis as the reason for reactions that actually occurred for completely different reasons. For example, if nobody sits next to you at the movie theater and you conclude that it's because of your psoriasis.
  • Magnification and minimization: This is playing down positive experiences, for instance not accepting compliments from other people or believing they only complimented you because they feel sorry for you, while also overrating negative experiences.
  • Catastrophizing: This is always expecting the worst possible outcome or overestimating the effects of an event: For example, you might go to a job interview thinking: "I won't get the job anyway because I have psoriasis."

It can take a lot of effort to stop thought patterns like these, and professional help such as psychological treatment may even be needed.

As well as seeing a skin specialist for the treatment of psoriasis, it may also be a good idea to get psychological help if you feel it is affecting your emotional wellbeing too much.