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There are many chronic health conditions that have a significant impact on people and their daily lives, yet they can be difficult to spot. The stranger on the bus who suffers from high blood pressure, or the soccer coach who deals with diabetes would not be assigned a “label” associated with their condition from a bystander or even a close friend. In contrast, psoriasis and other skin conditions are visible to others with significant impact on self-esteem, work, school, social interactions, and relationships. Valentine’s day is quickly approaching and while some are excitedly planning ways to celebrate with their partners, others are dealing with the emotional pressures, self-image, and fear due to their psoriasis. If you are feeling this way, you are not alone. We hope that this article can serve as reassurance for you and your partner to enjoy Valentine’s day for what it signifies: celebration of unconditional love.

 

The physical effects of psoriasis on relationships

Psoriasis is a common inflammatory skin condition that manifests as a raised, scaly rash that can happen anywhere on the body.1–3 It can be painful and itchy and sometimes cover a significant portion of the skin including genitals. People have reported avoidance and feelings of unattractiveness due to their psoriasis, especially among those in new relationships.5 The feeling of unattractiveness, stigmatization, and stress together can make some people completely shy away from relationships.

This is especially true in people with genital psoriasis. This population have been shown to experience impairments in sexual function and consequently engage in intercourse less frequently, avoid sexual relationships, and have decreased sexual desire.6–9 People may experience pain and symptom exacerbation during or after intercourse, and because of this, avoid sex. Genital psoriasis has been shown to remain untreated in up to two-thirds of psoriasis cases due to the stigmatization, shyness, and fear of judgement from a physician.6,10 Don’t be afraid to have a conversation with your doctors and ask for treatments that are targeted towards genital psoriasis.10 If your doctors don’t explicitly ask about how psoriasis is affecting your sex life, please tell them! This information is important to your care and treatment plan, and your doctor may be more conscious to ask you – or others – in the future.

Decreased intimacy with a partner is one of the most important physical impacts of psoriasis. A study conducted at the University of Western Ontario showed that 60% of patients with psoriasis who experienced decline in sexual activity attributed this to appearance, while only about 15% attributed the decline to decreased interest from their partner.11 This really highlights the importance of body positivity, and how poor self-image can impact relationships.

 

The emotional effects of psoriasis on relationships

We are often our own harshest critics and those with psoriasis are no exception. Psoriasis is associated with higher rates of mental health issues like anxiety and depression. Changes in mood, anxiety due to changing symptoms, and shame are just a few of the impacts that psoriasis can induce.2 It is not hard to imagine how these effects could permeate into all aspects of life, including relationships. With that said, a change in mindset from that of resentment and shame to control and understanding can have a significant influence on quality of life. Try checking in with yourself often so you can learn to recognize your personal clues about when psoriasis starts to impact your mood and your relationship. Be aware that a strong, healthy relationship starts with yourself. The best ways to gain control of psoriasis include appropriate medical care, stress relief, exercise, and a healthy diet. Never be afraid to seek help from medical professionals when your psoriasis is not being controlled or your psoriasis is significantly impacting your mood.

 

Talking to your partner about your psoriasis

Honesty and openness are key when discussing psoriasis with a partner. First, broaching topics we are self-conscious about in the context of a new relationship may be less difficult when you are confident and willing to answer questions. Humor can help, too, but try not to put yourself down – you are worthy of love!

Many people aren’t familiar with psoriasis and they may falsely assume it’s contagious. It is important to address this common concern with your partner. Beauty standards are shifting, and more and more celebrities and influencers are being candid about their skin conditions. For example, Kim Kardashian, an American media personality, has just recently begun to open up about her psoriasis and psoriatic arthritis. Cara Delavigne – a model, actress, and singer – also recently discussed her experience with psoriasis and how lack of knowledge led to people she worked with being afraid to touch her, fearing her condition was contagious. Though challenging, you can make a big impact by educating those around you, including your partner, about your experience with psoriasis.

Don’t let the elephant linger in the room! If it is on your mind, put it out there and talk about it.

 

Dating

The dating world can certainly be intimidating. With the advent of online dating (especially during the pandemic), vanity is often the difference between a swipe right or left. Online dating certainly has its challenges but being honest early about your psoriasis and its impacts on your life may help the development of a relationship. You could use those initial discussions and stages of getting to know each other to bring it up with positive language. Approaching a conversation with a positive attitude can create the opportunity for questions and a positive conversation. You have faced challenges dealing with your psoriasis and you should be proud of how you have managed them.

Unfortunately, we are not immune to stigma and criticism. If you receive negative reactions to your psoriasis, try not to be frustrated and know that it is not your fault. Likely that individual is not well-informed about psoriasis. Facing stigmatization is emotionally draining and it is very difficult to react in the moment. If you find that you have it in you, perhaps encourage that person to do some research for themselves. If that is too much in the moment, take a step back, gather some space, and know that you are not responsible for other people’s reactions.

 

Factors to consider during intimacy

 When it comes to intimacy, make sure that you are as comfortable as possible. Some people may have difficulty exposing their skin to their new partners, so take it one step at a time. Showing pictures of psoriasis to your partner can be the first step. If you are progressing towards intimacy in a new relationship, perhaps have a conversation in advance. Put it out there – your fears, what you are excited about, and anything else that may creep up and distract you in the moment.

Don’t be afraid of psoriasis standing in your way when you choose what to wear – find something that makes you feel sexy and confident. Choose fabrics that do not irritate your skin such as silk or cotton and ensure that your skin is well moisturized to minimize the scaly appearance of psoriasis. Know that you can communicate with your partner if things get uncomfortable or painful. Lubricants can help to reduce friction and subsequent pain and discomfort. Opt for lubricants that are unscented, as fragrance can irritate the skin or even cause allergic reactions. After intimacy, gently cleanse the skin and apply non-scented moisturizer to help keep your skin healthy and avoid irritation.

We do not get to choose the skin we have, but we can control how we treat ourselves and have the right mentality. It’s no doubt that psoriasis can be very challenging to live with. Be kind to yourself and realize that your body is incredibly capable and powerful. Showing our skin love and understanding encourages others to do the same whether they are a partner, family member, friend, or even a complete stranger.

 

References

  1. Lahousen T, Kupfer J, Gieler U, Hofer A, Linder MD, Schut C. Differences between psoriasis patients and skin-healthy controls concerning appraisal of touching, shame and disgust. Acta Derm Venereol. 2016;96. doi:10.2340/00015555-2373
  2. Sumpton D, Kelly A, Tunnicliffe DJ, et al. Patients’ Perspectives and Experience of Psoriasis and Psoriatic Arthritis: A Systematic Review and Thematic Synthesis of Qualitative Studies. Arthritis Care Res. 2020;72(5). doi:10.1002/acr.23896
  3. Feldman SR, Malakouti M, Koo JYM. Social impact of the burden of psoriasis: Effects on patients and practice. Dermatol Online J. 2014;20(8).
  4. Young M. The psychological and social burdens of psoriasis. Dermatol Nurs. 2005;17(1).
  5. Magin P, Heading G, Adams J, Pond D. Sex and the skin: A qualitative study of patients with acne, psoriasis and atopic eczema. Psychol Heal Med. 2010;15(4). doi:10.1080/13548506.2010.484463
  6. Yang E, Beck K, Sanchez I, Koo J, Liao W. The impact of genital psoriasis on quality of life: a systematic review. Psoriasis Targets Ther. 2018;Volume 8. doi:10.2147/ptt.s169389
  7. Meeuwis KAP, Van De Kerkhof PCM, Massuger LFAG, De Hullu JA, Van Rossum MM. Patients’ experience of psoriasis in the genital area. Dermatology. 2012;224(3). doi:10.1159/000338858
  8. Cather JC, Ryan C, Meeuwis K, et al. Patients’ Perspectives on the Impact of Genital Psoriasis: A Qualitative Study. Dermatol Ther (Heidelb). 2017;7(4). doi:10.1007/s13555-017-0204-3
  9. Ryan C, Sadlier M, De Vol E, et al. Genital psoriasis is associated with significant impairment in quality of life and sexual functioning. J Am Acad Dermatol. 2015;72(6). doi:10.1016/j.jaad.2015.02.1127
  10. Meeuwis KAP, De Hullu JA, Inthout J, et al. Genital psoriasis awareness program: Physical and psychological care for patients with genital psoriasis. Acta Derm Venereol. 2015;95(2). doi:10.2340/00015555-1885
  11. Gupta MA, Gupta AK. Psoriasis and sex: A study of moderately to severely affected patients. Int J Dermatol. 1997;36(4). doi:10.1046/j.1365-4362.1997.00032.x
Written by:      Selena Osman, MSc, Faculty of Medicine, University of Calgary
                         Harry (Chaocheng) Liu, MD, Department of Dermatology & Skin Science, University of British Columbia
                         February, 7 2021
Reviewed by: Dr. David Adam, February 10 2021

                                         

         

Over 40% of patients with psoriasis experience fatigue, which varies in intensity and duration from person to person.1 It is not to be confused with normal tiredness, since fatigue associated with psoriasis may not improve after rest. Symptoms of fatigue include:

  • an overwhelming sense of tiredness, which may persist even after a good night’s sleep
  • lack of energy
  • feeling physically and/or mentally exhausted2, 

 

Why do I feel fatigued and what causes it?

The exact mechanisms that cause fatigue in psoriasis are not clear. It is thought that fatigue may be a byproduct of inflammation, which is also the mechanism by which the symptoms in the skin and joints appear. The process of inflammation in the body is very complicated and triggers a release of an assortment of powerful chemicals, which exceed those usually present in the body.

For many patients fatigue is the most bothersome symptom of the illness, and should not be downplayed. Fatigue can interfere with physical, mental and social function and ultimately lead to withdrawal from usual social activities, causing sick leaves and disability. It is important to be aware of the fatigue symptoms and learn how to manage them to help lead a happier and healthier day-to-day life.4

 

How can fatigue from psoriasis affect my relationship?

The fatigue experienced with psoriasis can often indirectly impact relationships with partners and families. The disruption in sleep, reduced energy levels and lower productivity may require a partner to take on more responsibilities (household duties, additional sources of income). Such changes and imbalance in day-to-day activity can lead to a potential strain on the relationship.5

Impaired sexual function is also present in over 40% of men and women with psoriasis.6 This could be due lowered self-esteem with the lesion location, but also due to anxiety, depression and fatigue. It is important to take a note of how psoriasis impacts your sexual life and bring it up at your visits with a dermatologist. Awareness of the interplay of fatigue symptoms and impaired sexual function is important to take necessary management steps to improve overall life satisfaction.7

 

What can I do to manage and overcome fatigue that comes with psoriasis?

Fatigue can be managed through general lifestyle interventions:

  • Regular exercise8  - 
    • This may be difficult given muscle and joint pain (not to mention fatigue), but everything counts - do as much as you can without incurring pain and extra stress
    • Light to moderate cardio - biking, rowing, swimming, walking
  • Maintain a regular sleep-wake schedule and practice good sleep hygiene9  
    • Go to bed and wake up around the same time (~10PM - 7AM)
    • Reduce screen time 1-2 hours before bed
    • Limit intake of caffeine
    • Avoid sleeping pills, nicotine and alcohol - these may be effective at putting you to sleep, but lead to disrupted overall sleep
    • Sleep in a cool and dark room
  • Eat a diet rich in fruit and vegetables (ideally 5-10+ servings), low in saturated (animal) fat and minimal sugar; avoid processed foods as much as possible10 
    • Green leafy vegetables
    • Fish, avocado, nuts
    • Eat regular meals and try to lose weight if you are overweight

Remember to speak to your dermatologist about symptoms of fatigue. Some medications for psoriasis are better at improving these symptoms than others. Take the medications prescribed for psoriasis diligently, as they can help alleviate symptoms of fatigue and ultimately improve overall quality of life.

 

Being the partner of someone with psoriasis and understanding the fatigue.

Support from partners is very important for managing fatigue. It is important for partners to take the time and understand that this is a common symptom, beyond normal tiredness, that “ebbs and flows.” Here are some tips on how to help support a partner with psoriasis:

  • Your partner with psoriasis may be ashamed or try to downplay their symptoms - do your best to maintain an open dialogue, “check in” from time to time to monitor how they feel, and do your best
  • Accept that it is not your partner’s fault, they are not being “lazy” - psoriasis treatment is a complex and ongoing process - they may have “good days” and “bad days”

Other important notes11, 12

  • Take care of your mental health - psoriasis symptoms have a seasonal component, and tend to be worse in winter months when skin is more likely to be dry and itchy
  • The mental and physical exhaustion, and poor self-image can be further compounded by the impact of reduced physical activity and seasonal depression
  • Recognize symptoms of depression, agitation and anxiety associated with your fatigue and do your best to discuss these openly with your partner, close friends, family physician and dermatologist
  • Consider incorporating mindfulness meditation and relaxation techniques to reduce overall stress and improve sleep quality
  • If fatigue-associated/seasonal depressive symptoms are severe enough, they could contribute to further inactivity and dysregulation of your daily life - your family physician may recommend additional treatment for mood/mental health

 

References:

  1. Skoie IM, Dalen I, Ternowitz T, Jonsson G, Kvivik I, Norheim K et al. Fatigue in psoriasis: a controlled study. Br J Dermatol 2017;177:505-12.
  2. Rosen CF. Fatigue and psoriasis. Br J Dermatol 2017;177:346-7.
  3. Carneiro C, Chaves M, Verardino G, Drummond A, Ramos-e-Silva M , Carneiro S. Fatigue in psoriasis with arthritis. Skinmed 2011;9:34-7.
  4. Skoie IM, Ternowitz T, Jonsson G, Norheim K , Omdal R. Fatigue in psoriasis: a phenomenon to be explored. Br J Dermatol 2015;172:1196-203.
  5. Young M. The psychological and social burdens of psoriasis. Dermatol Nurs 2005;17:15-9.
  6. Duarte GV, Calmon H, Radel G , de Fátima Paim de Oliveira M. Psoriasis and sexual dysfunction: links, risks, and management challenges. Psoriasis (Auckl) 2018;8:93-9.
  7. Duarte GV, Calmon H, Radel G , de Fátima Paim de Oliveira M. Psoriasis and sexual dysfunction: links, risks, and management challenges. Psoriasis (Auckl) 2018;8:93-9.
  8. Sharif K, Watad A, Bragazzi NL, Lichtbroun M, Amital H , Shoenfeld Y. Physical activity and autoimmune diseases: Get moving and manage the disease. Autoimmun Rev 2018;17:53-72.
  9. Henry AL, Chisholm A, Carter LA, Bundy C, Griffiths CEM , Kyle SD. The relationship between sleep disturbance, symptoms and daytime functioning in psoriasis: a prospective study integrating actigraphy and experience sampling methodology. Sleep Med 2020;72:144-9.
  10. Ko SH, Chi CC, Yeh ML, Wang SH, Tsai YS , Hsu MY. Lifestyle changes for treating psoriasis. Cochrane Database Syst Rev 2019;7:Cd011972.
  11. Wu JJ, Feldman SR, Koo J , Marangell LB. Epidemiology of mental health comorbidity in psoriasis. J Dermatolog Treat 2018;29:487-95.
  12. Ferguson FJ, Lada G, Hunter HJA, Bundy C, Henry AL, Griffiths CEM et al. Diurnal and seasonal variation in psoriasis symptoms. J Eur Acad Dermatol Venereol 2020.
Written by:   Richie Jeremian,PhD, Faculty of Medicine & Health Sciences, McGill University
                    Yuliya Lytvyn, PhD, Temerty Faculty of Medicine, University of Toronto, February 7, 2021
Reviewed by:     Dr. David Adam, February 10, 2021
Translated by:  Liliane Chenard, February 13 2021

PsoIntimate cover 4

On February 14th we are launching our #PsoIntimate campaign; a campaign aimed at tackling the issues around psoriasis and relationships. 

We will be featuring new content on our website on genital psoriasis, psoriasis and relationships, and psoriasis and fatigue.  Be sure you are following our social channels  (Facebook, Twitter, and Instagram) to be a part of the conversation.  

We will also be hosting a live Q and A session with dermatologist Dr. David Adam.  Be sure to join us on February 16th at 7pm EST for this session, and have your questions about psoriasis and relationships answered.  Preregistration is required and you can register by clicking here.  

 

We are grateful to the following sponsors for their support of the #PsoIntimate Campaign:   
 1  novartis  SUNlogo cmyk

What is Genital Psoriasis

Psoriasis is a chronic autoimmune disease that affects approximately up to 3% of people in Canada. Men and women are affected equally. The condition causes red scaly plaques across the body.

Genital psoriasis (GP) is a type of flexural psoriasis, meaning areas like the folds in the armpits, groin, and buttocks tend to be affected. Many people with psoriasis will see these areas affected. GP is an underreported condition as patients are often too embarrassed to discuss their symptoms with their healthcare provider (Fouéré et al.). The right treatment can help get rid of the itch and clear the psoriasis.

 

Symptoms

The skin of the genital region is very sensitive and fragile, which makes it more susceptible to being irritated by chemicals and clothes or other items. Common irritants include tampons, tight clothes, shaving, sweat, lubricants, discharge, and soaps. GP classically presents with itchiness. It usually presents as red and itchy plaques of skin that have a clear outline and do not have any scales that are commonly seen in psoriasis on other parts of the body.

In women, psoriasis affecting the vulva tends to be symmetrical (appear on both sides), with red or grey plaques affecting the labia majora (Welsh et al.).

In men, GP can affect both the skin of the scrotum and penis. The most commonly affected area is the glans penis, which is the tip of the penis. When taking a history, your healthcare provider may ask you details about whether psoriasis runs in the family, your sexual activity, and skin lesions in other areas.

 

Diagnosis

GP is diagnosed based on a clinical examination by your healthcare provider. Your healthcare provider may ask you about genital complaints and examine the genital area if they see psoriasis affecting other areas of your body. They may look for the presence of psoriasis in other areas of the body such as the nails, scalp, and behind the ears. GP can look like other conditions such as dermatitis, candidiasis, balanitis, vulvitis, syphilis, and certain skin cancers (Meeuwis et al.).

 

Treatment

The genitals are a particularly challenging area to treat due to their warmth, friction, and moisture. Treatment for GP is generally topical. Conservative treatment starts with mild moisturizers and avoiding things that may irritate the skin in this area (Edwards et al.). The most common option is topical corticosteroids and treatment often begins with a mild steroid. Other commonly prescribed agents include topical calcineurin inhibitors. While used for other affected areas, phototherapy is not recommended for treating psoriasis in the genital areas (Menter et al.). If a patient fails all topical therapy, there are some cases when systemic treatments (small molecules or biologics) are initiated (Bangsgaard et al.) It is important to note that there is no single treatment that works for everyone. You may need to try multiple treatments before finding the one that works best for you.

 

Lifestyle changes

There are steps you can take to avoid irritating your GP. When treating GP, use the treatment that your dermatologist specifically prescribed for that area. Treatments for other parts of the body can be harmful to the genitals. Use mild, fragrance-free cleaners in the bath. Avoid antibacterial soaps and body washes as they can irritate the delicate skin of the genitalia. Moisturize frequently especially after bathing to reduce irritation. Wear loose fitting clothing and underwear to minimize friction.

 

Feeling embarrassed

GP is an embarrassing condition for many patients. Often, patients do not know where to seek professional advice or are too ashamed to disclose their situation to a healthcare provider. To make things worse, lack of social awareness leads to people confusing GP with sexually transmitted infections. Patients may try to treat their GP with other remedies, which may exacerbate their condition. Proper communication between a team of multidisciplinary healthcare providers and patients is very important to improve patients’ quality of life.

 

Things to consider when being intimate

GP can have a very negative impact on quality of life. It is a condition that affects a person’s physical, psychosocial, and emotional health. Psoriasis has a greater effect on general wellbeing than many chronic diseases including cardiovascular disease and diabetes. Over 80% of patients with psoriasis report challenges with their relationships with others (Finlay and Coles).

Psoriasis affecting the genitals and the face may be associated with suicidal ideation and depression. In some studies, almost 10% of subjects reported a wish to be dead (Gupta et al.). A recent study on the quality of life and sexual life of patients with psoriasis concluded that patients who have genital lesions report worse quality of life than those without genital lesions, sexual distress is highest when genital skin is affected, and that patients generally believe that the attention given to sexual challenges for patients with GP by healthcare professionals is insufficient (Meeuwis et al.). The main factors decreasing sexual activity in patients with psoriasis are shame and embarrassment over their physical appearance, lower sexual desire, scaling skin, and the inconvenience of using topical treatments (Meeuwis et al.).

You can still enjoy being intimate if you have GP. You can reduce irritation by following some basic steps.  It is important to stay on schedule with the use of topical treatments. By keeping the psoriasis as clear as possible it will minimize any potential irritation from sexual activity. In a new relationship, It is important to communicate to your partner that psoriasis is not contagious and to have some conversation about the condition. If your genital skin is poorly controlled or flaring it may be wise to postpone any sexual activity that would involve that part of your body.   Psoriasis is triggered and worsened by trauma, therefore for any sexual activity one should ensure that adequate lubrication is used. Excessive friction can exacerbate psoriasis.

References:

  1. Edwards SK, Bates CM, Lewis F, [et al.]. UK national guideline on the management of vulval conditions. Int J STD AIDS. 2015, 26, 611–624
  2. Menter A, Korman NJ, Elmets CA, [et al.]. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photoche-
  3. Bangsgaard N, Rørbye C, Skov L. Treating Psoriasis During Pregnancy: Safety and Efficacy of Treatments. Am J Clin Dermatol. 2015, 16, 389–398.motherapy. J Am Acad Dermatol. 2010, 62, 114–135.
  4. Fouéré S, Adjadj L, Pawin H. How patients experience psoriasis: results from a European survey. J Eur Acad Dermatol Venereol. 2005, 19, 2–6.
  5. Welsh BM, Berzins KN, Cook KA, [et al.]. Management of common vulval conditions. Med J Aust. 2003, 178, 391–395.
  6. Meeuwis KAP, de Hullu JA, Massuger LFG, [et al.]. Genital psoriasis: A systematic literature review on this hidden skin disease. Acta Derm Venereol. 2011, 91, 5–11.
  7. Finlay AY, Coles EC. The effect of severe psoriasis on the quality of life of 369 patients. Br J Dermatol. 1995, 132, 236–244.
  8. Gupta MA, Schork NJ, Gupta AK, [et al.]. Suicidal ideation in psoriasis. Int J Dermatol. 1993, 32, 188–190.
  9. Meeuwis KAP, de Hullu JA, van de Nieuwenhof HP, [et al.]. Quality of life and sexual health in patients with genital psoriasis. Br J Dermatol.2011, 164, 1247–1255.

Written by: Aryan Riahi, fourth year medical student at University of British Columbia, January 23, 2021

Reviewed By: Dr. David Adam, February 3, 2021

This fall, the Canadian Association of Psoriasis Patients conducted a survey about the impacts of COVID-19 on the psoriasis and psoriatic arthritis community, in collaboration with the Canadian Psoriasis Network and an awareness group in Saskatchewan, Unmasking Psoriasis. The support from our community was incredible, with over 800 responses to the survey. We also held two virtual discussion groups to dive deeper into some of the themes that we uncovered from the survey:

  • It is difficult to access dermatological care from a specialist across Canada
  • There are many barriers to accessing treatments, and
  • There is still much we do not yet understand about psoriasis and psoriatic arthritis.

This infographic sets out the highlights of our survey results, including the fact that these diseases impact multiple aspects of people's lives. Many people experienced changes to their treatment plans since the onset of the pandemic. Most had a virtual visit with their healthcare provider during the pandemic, but there is a lot of room for improvement.  Nearly half of survey respondents indicated that their mental health has worsened during the pandemic. 

There are many areas where the federal government can better support people living with psoriatic disease. We are actively sharing this information with federal Members of Parliament in recognition of World Psoriasis Day. If you need support or would like to get involved, please let us know at !

(click to enlarge)

CAPP CPN UP Psoriasis COVID 19 Survey Infographic Oct 2020 Image

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