People with psoriasis often face stigma, discrimination

(Reuters Health) - People with the scaly skin condition psoriasis are often faced with people who don’t want to shake hands with them and who see them - incorrectly - as contagious, according to a new study.

“Patients with psoriasis often express frustration to me that they experience discrimination in public places and the work environment,” study coauthor Dr. Joel Gelfand of the University of Pennsylvania in Philadelphia told Reuters Health by email. “My patients tell me that they have been asked not to use a pool, feel embarrassed going to the hair salon or have been fired from jobs that require interaction with the public.”

Psoriasis is an autoimmune disease that speeds up the lifecycle of skin cells, causing them to build up rapidly on the surface of the skin. The extra skin cells cause scales and red patches that are itchy and sometimes painful. Some people with psoriasis develop arthritis, too.

According to the National Psoriasis Foundation, up to 7.5 million Americans, or roughly 2 percent of the population, have psoriasis.

Gelfand and colleagues surveyed two groups of people without psoriasis: 187 medical students at the University of Pennsylvania, and 198 adults from’s Mechanical Turk data collection service.

The survey displayed images of people with psoriasis, including enlarged images of psoriatic skin. Participants were asked to rate the extent to which they felt compassion, pity, disgust, blame, contempt and curiosity in response to the images. They were also asked to choose adjectives that describe someone with psoriasis, such as “clean” or “dirty,” and rate their beliefs about common myths and misconceptions around psoriasis.

Overall, about 54 percent of people said they wouldn’t want to date someone with psoriasis, 40 percent said they wouldn’t want to shake hands, and 32 percent said they wouldn’t want to have psoriasis patients in their homes. The most frequently endorsed stereotypes were that people with psoriasis are insecure, sick and unattractive. A third of participants also endorsed myths that psoriasis only affects the skin and is not a serious disease.

“Despite so much progress in our understanding of the immunology, genetics, comorbidities and treatment of psoriasis, harmful myths and stereotypes about this common disease are pervasive,” Gelfand said.

People who knew someone with psoriasis were less likely to report myths and stereotypes, however. Even those who had previously heard of psoriasis were more likely to report more compassion, less blame, and less contempt.

“This suggests that learning more information about the disease and having positive interactions with people who have psoriasis may help to dispel myths and stereotypes,” said coauthor Rebecca Pearl of the University of Pennsylvania.

Pearl, Gelfand and their coauthors plan to keep studying public attitudes, including patients’ reports of stigma experiences, so they can better understand the social and psychological burden of the disease. Future studies should test whether educational campaigns could reduce the myths and stereotypes around psoriasis, they wrote in the Journal of the American Academy of Dermatology.

“It is important to remember that outward appearance does not give us information about internal characteristics or personality traits,” Pearl told Reuters Health by email. “Everyone can pause and reexamine or challenge their beliefs and assumptions as a first step toward reducing stigma.”

Part of this includes educating doctors and medical students, too. Although the students agreed with fewer myths and stereotypes, some of them still held stigmatizing views. Even if they don’t act on or express these thoughts, it could inhibit diagnosis, treatment, and understanding the psychosocial issues that patients face.

“Patients feel embarrassment and shame attached to their condition, but it’s not often recognized by doctors,” said Katie Wang of the Yale School of Public Health in New Haven, Connecticut. Wang, who wasn’t involved with this study, has researched the burden of stigma on health and well-being.

“We all need to learn more about medical conditions instead of make assumptions based on our previous knowledge,” she told Reuters Health by phone.

SOURCE: Journal of the American Academy of Dermatology, online August 29, 2018.