Although some studies find that demographic factors such as sex didn’t predict psychosocial outcomes in psoriasis, there is evidence that points to the unique experiences of women compared to their male counterparts.
Overall, women experience more severe health-related quality of life challenges compared to men. One report analyzing survey data from nearly 5,000 patients found 20% of women said psoriasis is a very large problem in their everyday lives, compared to 12% of men. Nearly 60% of women said psoriasis interferes with their capacity to enjoy life, compared to 52% of men. In addition, a 2018 World Psoriasis Happiness Report finds that women with self-reported psoriasis identify as less happy, more lonely and isolated and more ashamed of their condition than men with psoriasis overall.
This section explores what the research says may be behind some of this. Be sure to check out the Spirit section of this guide for strategies to consider if and when you may experience some of these challenges.
The majority of respondents to CPN’s survey of women-identified people with psoriasis and psoriatic arthritis expressed strength, positivity, self-confidence and embracing oneself as part of their experience with living with these conditions. This is particularly important because we know from research that negative self-image can be related to depressive symptoms in people with psoriatic conditions.
One study found that depressive symptoms in women were associated with how they evaluated their appearance and how they evaluated their health. This research found correlations between lowered mood and psoriasis severity, and lowered mood and negative body image.
Research that looked at understanding social anxiety and depression in people with psoriasis, found that in patients with adult-onset (≥18years of age), the importance of appearance to one’s sense of self-worth was the main contributor to social anxiety. Whereas in patients with pre-adult onset (under 18), social anxiety was most strongly related to experiences of stigmatization. The same study also concluded that female gender and the degree to which one bases their perceived social worth and sense of self on physical appearance were related. It’s also important to note that it has been shown that impacts of disfiguring conditions on an individual are not proportional to the degree of disfigurement; even mild symptoms can have a large impact on one’s life.
People with psoriasis often report poor self-esteem and high levels of psychological stress. Those with more severe disease or with involvement of a more visible area (e.g., face, scalp) or highly utilized area of the body (e.g., hands) may suffer disproportionately from these problems.
In one study where participants reported some level of stigmatization, regardless of the location or type of psoriasis they experienced, women reported higher levels of stigmatization than the participants who identified as men. Specifically, compared to men, women reported higher perceived stigmatization in areas such as: anticipation of rejection; feelings of being flawed; and sensitivity toward the opinions of others. In fact, the study showed that women reported greater levels of stigmatization when compared to men, despite significantly lower psoriasis severity. It also found that these experiences were even more pronounced if psoriasis lesions could not be hidden by clothing.
It is also well-reported that people with psoriasis and/or psoriatic arthritis are at a higher risk of experiencing mental health issues such as anxiety and depression than the general population, for physiological and social reasons. Estimates suggest that up to 30% of patients with psoriasis may develop anxiety and up to 60% may develop depression over the course of the disease. One study found that there was a 1.25-fold likelihood of depression among women with psoriasis and a 1.52-fold higher likelihood of depression among those with psoriatic arthritis, compared to women without psoriasis.
Another study that looked at health-related quality of life (HRQol) impairment (a concept that includes areas related to physical, mental, emotional, and social functioning), found that the severity of HRQol in women was twice that observed in men. This paper also cited research which suggested that men found it easier to cope with the social effects of psoriasis than women, and that women are more likely to feel distressed or embarrassed, relative to men.
The effects of psoriasis on social and intimate relationships can also be significant. Research suggests that for some people, difficulties with self-image, low self-esteem and feelings of stigmatization could lead to avoidance of attending social events, pursuing relationships, dating and intimacy. Studies also find that the more extensive the disease involvement, the greater the impact on intimacy; moreover, patients with genital, nail, face, neck, or scalp involvement had showed a higher impact on intimacy than those without.
The potential impacts of a chronic condition like psoriasis and/or psoriatic arthritis on one’s life extends beyond the individual to their families and their circle of care. In addition to the potential emotional and social effects already mentioned, psoriasis can have significant impact on individual and family finances.
Apart from direct costs related to treatment of the disease itself, 59% of working patients in one study reported that they lost or were unable to find work for certain periods within the preceding year due to the effects of psoriasis or its treatment. Being able to access affordable treatment can also be a challenge, especially if a person does not have private health insurance. In fact, 10% of CPN’s survey respondents indicated that they pay for their medication treatments out-of-pocket and 3% responded that they don’t take medications because they cannot afford them.