April 23, 2019 / All Stories

Psoriasis psychology: pushing past the disease

Psoriasis is a chronic illness that affects the skin, but patients and experts will tell you its impact can go much deeper.

More than skin deep

She has a brand new outfit. It’s hot out, so naturally the shirt has short sleeves. She fixes her hair, applies some lip gloss. For the finishing touch, she throws on new earrings and is ready for a fun night out with friends. But after that last look in the mirror, she hesitates. She sees her elbows are exposed. After a recent flare, her psoriasis is visible all over her arms. Thoughts enter her mind of leaving flakes of skin at the dinner table or having strangers and even her friends stare. She now wants to sit at home and miss another night out with friends.
Data compiled by the World Health Organization shows this emotional battle is common among the 125 million people worldwide who have psoriasis, and a familiar struggle that Dr. Alexandra Mizara sees in her London-based psychodermatology office.1

Dr. Alexandra Mizara is a London-based psychodermatologist.

Psychodermatology is a practice that treats psychological disorders linked to the skin. In the United Kingdom, Dr. Mizara leads the one of the very few centers to offer this service. In all of Europe, Dr. Mizara says there are only a few dermatology departments with psychodermatologists available. In the United States, the Association for Psychoneurocutaneaous Medicine of North America only lists nine psychodermatologists on their website.
“Working on the connection between the mind and the patient’s skin is not hugely recognized among medical professionals, but I’ve seen illnesses related to the skin aren’t just biological,” says Dr. Mizara.

The gap in psoriasis care

Dr. Mizara moved to London 18 years ago to start her research in dermatology with a focus on ways a visibly altering condition can impact people well beyond their skin. Currently in her practice, people with psoriasis make up the second largest group of referrals.
“My understanding of the skin is different. Most dermatologists can talk about treatment and how to manage the conditions, but I look at more than the disease. I assess appearance, symptoms like itchiness, body image and how all of that affects their self-esteem,” explains Dr. Mizara.
Dr. Mizara’s patients say she dives deeper into their psychological, social and emotional challenges – areas they felt other dermatologists didn’t typically consider in the course of their care.
Anne Robinson, PharmD, executive scientific director, AbbVie, has seen a similar gap in care in her nearly 15 years working in immunology. “There are still many health care providers who view psoriasis as just a skin disease. I truly feel for those patients because their dermatologist isn’t always looking at how skin clearance could impact their quality of life,” says Robinson.
Anxiety and depression are two of the common mental health issues Dr. Mizara tackles with her psoriasis patients. She says it can take 12-20 sessions to work on improving core self-esteem and overcoming shame which can alleviate symptoms like anxiety and depression.
“It’s so much more than appearance with psoriasis patients, but they don’t always see that or feel that their doctor recognizes their disease is more than skin deep,” says Dr. Mizara.

Building a community of understanding

Progress has been made in the last decade to address the psychological and emotional care gap for people with psoriasis, yet some are still falling through the cracks.
“With all the advancements in medicine today, we’re still seeing patients who don’t feel heard. We’ve seen them not return to their doctor out of frustration,” says Robinson.
One of the goals at the National Psoriasis Foundation is to further educate patients on their care options, the severity of their disease and the importance of receiving the appropriate help for their illness. More than a year ago, the organization launched a campaign centered on mental health.

“We see the full scope of emotional pressure,” says Emily Boyd, chief revenue officer, National Psoriasis Foundation. “One of the top three calls we receive in our patient navigation center is about emotional struggles. Patients don’t always know who to turn to anymore. It’s heartbreaking to hear.”
The impact even reaches a socioeconomic level. The World Health Organization has found people with psoriasis either miss days of work or even lose out on a job opportunity because of the shame they feel.
Dr. Mizara believes psychoeducation is important, particularly for health care providers. In her office, dermatologists often refer patients to her. This process includes a psychological assessment similar to what an OBGYN may provide a pregnant woman when trying to determine her risk for post-partum depression.
Mizara has found the emotional well-being of her patients tends to align with the state of their skin condition, and for those with psoriasis, she’s seen their physical symptoms suppress personal and professional aspects of their life. Once these individuals move past their disease, both physically and emotionally, Mizara has seen drastic changes in how they live.
“I’ve worked with plenty of psoriasis patients who have turned their life around. Today, having psoriasis is no longer the central issue in their life. They recognize they can do things they thought they couldn’t do before. They no longer feel limited by their disease,” says Mizara.


Media inquiries

Brittany Seagraves
Email: brittany.seagraves@abbvie.com
Call: + 1 224-229-2144

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