Relationships, hobbies and everyday life with psoriasis

People with psoriasis often spend a lot of time and effort hiding their skin condition from others. This is especially true of teenagers and young adults, for whom appearance is often particularly important. But it can be 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.

Being too concerned about whether people can see your psoriasis greatly restricts your everyday activities. It's not always easy to be more relaxed about your appearance. But if you manage to let go a little, you can focus on what you really want to do and then go for it.

Psoriasis on the hands or nails can be very unpleasant – particularly for those who have a job that involves dealing with a lot of other people. 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 involving close physical contact or sports like swimming. Some people who have severe psoriasis even avoid looking at themselves in the mirror.

The way people feel about their psoriasis often changes over time: It's often 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 things are easier if you accept the disease as part of your own body. Many wish they had managed to do this earlier. Sharing your experiences and feelings with others who are in a similar situation – for instance, in a support group – can help you cope better with the disease.

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 can be very helpful to develop a general positive attitude and recognize that a lot of people aren't satisfied with their body and feel insecure for other reasons, even though they don't have a skin condition. It is good to know that many people with psoriasis find a partner who accepts them as they are.

Talking openly about your psoriasis can help you to relax and avoid misunderstandings – before becoming intimate with someone, too. The other person will then be 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, so water-based lubricants are more suitable. It should be clear from the product package whether or not it can be used together with a condom.

If a cream or ointment is used for the treatment of psoriasis in the genital area, care should be taken to prevent it from getting into a woman's 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.

People with psoriasis sometimes notice others staring at them. This is usually not done to be mean – instead, it's 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.

It can help to remember that when people stare it is often simply out of curiosity, surprise or ignorance. Most of us sometimes take 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. Remembering that might make it easier to ignore other people's comments and glances, or turn away from them.

But there's no one answer to the question of how best to deal with such reactions. One friendly way to signal that you have noticed someone's glances may be to seek direct eye contact with them. That may make them aware of their behavior and they might stop looking at you.

You could also tell the person directly that you would prefer not to be stared at. Gathering the courage to talk to them may help to relax the situation 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: "You staring at me like that is making me feel uncomfortable."

Some people might even ask you about your skin themselves. Then offering a simple explanation is often enough. For instance: "I have a chronic skin condition called psoriasis. It isn't contagious, though."

It can be hard to deal with other people's reactions. Whether or not you respond to them will vary from person to person. It often depends on how you're feeling at the time too.

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 may feel relieved once the "psoriasis issue" has been talked about.

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.

Certain thought patterns sometimes add to the distress. 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.
• Minimization and magnification: 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."

Psoriasis is so distressing for some that they develop 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 then lead to depression or to alcohol or drug abuse.

As well as seeing a skin specialist (dermatologist) 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. There are various places you can turn to, including psychotherapist practices. Changing harmful thought patterns can be quite hard work and professional help is sometimes needed.