The Top 5 Concerns of Women with Psoriasis: An Interview with Dr. Lawrence Green

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According to the National Institutes of Health (NIH), up to 7.5 million Americans have Psoriasis which equates to about 2.2 percent of the population. Although the percentage of women who have psoriasis is about equal to that of men, this chronic skin condition seems to have a much more dramatic psychological effect upon women.

The National Psoriasis Foundation reports that in an analysis of survey data from 5,000 psoriasis patients, 20 percent of women said that psoriasis was a very large problem in their everyday lives, compared to only 12 percent of men. In addition, approximately 60 percent of women said that psoriasis interferes with their ability to enjoy life, as compared to only 52 percent of men. Overall, women have a much more difficult time dealing with the psychological and social issues brought about by having psoriasis.

We are going to explore the psychosocial impact of psoriasis upon women in greater depth by talking to Dr. Lawrence Green, a dermatologist who regularly sees women who suffer from psoriasis in his private practice in Rockville Maryland.

Welcome Doctor Green to My Skin Care Connection.

Can you tell us a little bit about yourself and what you do?** Dr. Green:**   I am an Assistant Clinical Professor of Dermatology at George Washington University School of Medicine in Washington DC, but more importantly for your article, I am also on the Board of Trustees of the National Psoriasis Foundation. I see patients every day in my Rockville, Maryland office and can be contacted through my  website. Although I do a fair amount of cosmetic medical procedures, I have psoriasis myself and have always made treating people with psoriasis a priority in my office.

What is psoriasis?** Dr. Green:** Psoriasis in a chronic autoimmune condition, that affects the skin, and can also affect the joints in some people. Basically, one's own immune system (for unknown reasons) stimulates the skin to reproduce itself too rapidly and/or also cause proliferation and possible destruction in one's joints (for those who have psoriatic arthritis).

What usually prompts a woman to come in and see her doctor about the symptoms of psoriasis?** Dr. Green:** I think women are concerned when psoriasis can be visibly seen on them. Having psoriasis in a clothed area of the body is annoying, but not as disfiguring as having it on visible places. And visible places would include on the scalp where flakes constantly fall down from your hair onto your clothes and can be noticed by others.

The National Psoriasis Foundation reports that psoriasis can have a profound effect upon a woman's psychological health and that there is some scientific evidence to show that some women who are diagnosed with psoriasis will also suffer from depression and even suicidal ideation. In your experience as a dermatologist, have you seen evidence of this in your practice?** Dr. Green:** Personally, I have seen female (and male) patients become very depressed and break down/cry in my office during their visits with me when discussing their psoriasis. This has occurred whether the psoriasis is mild or severe-but the unifying theme is that it is visible to others. Just today, I had a female patient who felt very depressed and said she has limited her leaving her house for the past month because of her psoriasis. She also said even though her husband stated he didn't care the least she had psoriasis and still told her how much he loved her, she couldn't get herself be intimate with him because of how she looked.

From your perspective as a doctor, what are the top five concerns of women with psoriasis? What are the issues which distress them the most?** Dr. Green:** I don't know if I can give you top five, but women are most concerned with how they can make their psoriasis go away (just like everyone else). And treating psoriasis everywhere, but especially in visible areas (including the scalp) is most important. They are often tired of having to alter how they dress (ie. to cover their psoriasis).

Literature from The National Psoriasis Foundation validates Doctor Green's assessment of what issues concern women the most when dealing with their psoriasis.

1. Psoriasis is a chronic condition for which there is currently no cure but it is possible to have periods of remission. The primary concern of many women (and men) who are diagnosed with psoriasis is how to lessen their symptoms. The good news is that there are many treatment options for psoriasis sufferers. If you have psoriasis you will want to ask your dermatologist about which treatment options are best for you.

2. As Doctor Green has stated, many women are especially concerned about treating psoriasis in visible areas of the skin, including the scalp. It is estimated that half of the people who have psoriasis will have it on their scalp area. You can read about the many ways to treat scalp psoriasis from the National Psoriasis Foundation.

3. Women who are diagnosed with psoriasis often worry about how to dress to cover up their psoriasis. And too, some clothing options may present problems such as wearing dark clothes as the flaking and scales from psoriasis may show up more visibly. Tim Gunn, who you may know from the show, Project Runway, has some tips for how to dress with style despite your psoriasis.   One of Tim's inspirational quotes from the "Address Your Psoriasis" website is: "How you dress sends a message about who you are. It's time to dress for you, instead of for your psoriasis."

4. In addition to worries about clothing, women with psoriasis are also concerned about cosmetics. They want to know how to wear make-up which may minimize the appearance of their affected skin. There are many articles on-line about how to use makeup to disguise the effects of Psoriasis. For example, you can read about 4 Makeup Tips from Doctor Susan Taylor.

5. Women who are diagnosed with psoriasis also worry about their relationships. Some women may be afraid of how they look to their boyfriend or spouse. Psoriasis can even impact upon intimacy and sexual relations as pointed out by Doctor Green. In a National Psoriasis publication entitled, Women and the Heavy Toll of Psoriasis, the author states that Psoriasis can impair a woman's confidence and ability to form key relationships. As a result, it is critical for any woman with psoriasis to seek out help for any psychological issues pertaining to her skin condition.

Are there any ways for women to cope with the social and psychological aspects of having a chronic skin condition such as psoriasis?** Dr. Green:** I am not a psychological expert by any means, but I tell patients to trust in and talk to their loved ones to help them through the hard times when they have a lot of psoriasis. There is also much support from the National Psoriasis Foundation, which has sounding boards where people with psoriasis can talk with each other. The NPF also has dedicated staff to talk to people live about their psoriasis. And of course, if needed, professional counseling can be very helpful. But most important is to find a dermatologist who can treat them. There is no need to continue to suffer from psoriasis since today there are so many treatments that really control psoriasis so well.

Doctor Green, we wish to thank you for sharing your time and experience with us.

Here are some additional resources about psoriasis management and support for our readers: