'Ugh...how do you catch that?': a qualitative study of the impact of psoriasis on social interactions

Abstract

Background Psoriasis is associated with considerable psychological disability. Due to the visibility of skin lesions, patients with psoriasis commonly report experiences of stigmatization and public rejection. Objectives We aimed to gain insights into individuals' experiences of the extent, type and management of psoriasis-related social interactions and the long-term impact on social functioning. Methods Qualitative, semi-structured interviews (n = 24 participants) were used to elicit the views and experiences of patients with psoriasis. Data were analysed using inductive thematic analysis. Results Our analysis produced four overarching themes: (i) varied experiences of psoriasis-related interactions, (ii) threat to the sense of self, (iii) preserving social connections and (iv) missed opportunities for positive interactions. Psoriasis had a considerable impact on the participant's social interactions. Although overtly negative reactions from other people were rare, even supportive comments were appraised negatively by patients as an unwanted reminder of the disease. Patients' behaviours in social situations were motivated by desires to minimize further attention, preserve their self-identity and protect existing social relationships. Periods of social avoidance contributed to a damaged sense of self and decreased confidence in communication skills. Conclusions Living with psoriasis may present unique social challenges. Even when the skin is well controlled clinically, patients may struggle to re-engage socially. The damage to the sense of self and decreased confidence in communication skills suggests that psychological therapies such as acceptance and commitment therapy and social skills training may be beneficial.