Psoriasis and COVID-19



The COVID-19 pandemic has had far reaching impacts.

We’ve all experienced enormous changes in our lives.  We are home schooling and our teenagers are feeling grounded and isolated from their friends.  We’re missing loved ones and our working lives are unrecognisable.

Some people with psoriasis are having to shield because of the immunosuppressant medication they take and now have to consider themselves ‘extremely vulnerable’ which must be very strange, especially if you’re feeling well.

For others, the lockdown has meant dermatology appointments cancelled, even longer waiting lists, systemic treatments stopped or postponed and phototherapy put on hold.  Increased hand washing and alcohol gels can leave hands sore and cracked.

For me, the past few months have seen my psoriasis flare up. In February we had a family holiday and for the first time in many years I went away with clear skin and there were no stresses about swimming or wearing shorts. But jump forward to June and I’m now back to angry plaques over most of my body.  I put this down to the big changes in my routine.

Work was intense for the first few weeks of the pandemic as we prepared ourselves to deal with the situation.  As a busy clinical psychologist working in the NHS, I needed to adapt to virtual therapy, to support patients who had started shielding as well as providing support for front-line staff.  Overnight I saw big increases in anxiety and distress in both patients and staff.

I went from never having done virtual therapy to back to back zoom sessions every day. Working in two different part-time roles from home meant I was inundated with urgent emails and my working day continued into the evenings and over the weekend.  Shifts working in the hospital became a fearful experience and I worried about picking up the Corona virus and bringing it back home to my family.  All the while my children were adjusting to home schooling and also needed help and support to navigate this.

What all this meant for me was my well established routines were very disrupted.  I normally follow a whole food plant-based (WFPB) diet but began to eat more convenient, comfort foods with a few glasses of wine here and there.  My sleep was also really poor and when I did manage to drop off, my dreams were vivid and frightening.

Things have started to settle down, as they have a habit of doing.  I’ve adjusted to the new ways of working and we have begun to establish new norms.  My diet is almost back to WFPB and I’ve started taking probiotics which has made me feel much better inside and out.

This has led me to reflect on how psoriasis often reacts badly to changes in routine and perhaps this is why people often feel that stress makes psoriasis worse.

As the weeks and months pass, we‘ll learn more about the impact of COVID-19 on chronic health conditions like psoriasis.  The International Psoriasis Council has up to date information on coronavirus and psoriasis. The Psoriasis Association is also a great source for support, information and resources.

It’s important to remember

  • If your psoriasis has flared up you can still make an appointment with your GP, they will have measures in place to keep you safe.  Your dermatology clinic may be offering virtual clinic appointments too.
  • Be kind to yourself.  Life has changed for all us but we will get back to normal. Don’t fret if your diet has gone a bit awry.  Enjoy the indulgences and pick up again when you feel less stressed.
  • Read this for advice on getting a better night’s sleep.
  • Join a psoriasis forum and talk with other people with psoriasis.  It’s a great way to get support.
  • Stay safe.


How has the pandemic affected you?  Please leave a comment below.

How to support your child with psoriasis

A significant proportion of people with psoriasis first develop it in childhood.  As a parent it’s incredibly hard to watch your child struggle and you can be left feeling quite helpless.  Here are my top tips for supporting your child:


Your instinct will be to try and fix things.  But you can’t.  Listening is the most important thing you can do.  Your child needs you to hear how tough things are.  Reflect back what you heard so they know you understood:  “It sounds like things were pretty tough today”.  If you don’t know what I mean then watch this short animation about empathy.

Prepare them

People will ask questions, point, stare, grimace.  Unless you plan to keep your child at home or covered up for the rest of their lives then get them prepared to deal with unwanted attention.  Teach them the Explain-Reassure-Distract method and practice, practice, practice.

Help them get control

Encourage them to speak in clinic appointments and take responsibility for their own treatments.  Try not to nag and remember to give lots of praise if they do their treatments by themselves.  For younger children consider using a reward chart.

Build their confidence

Tell them they’re wonderful and all the reasons why.  Are they funny, kind, clever or creative?  Your child is much more than skin so remind them of that.

Don’t force them to uncover

Don’t make them show their skin if they don’t feel ready.  It might not look awful to you but it takes a lot of courage to show skin covered in psoriasis to the world.  If they’re not ready it will just be horrible.  So what if they want to wear trousers instead of shorts?  Join them!

Inspire them

Watch movies with inspiring characters.  Read books where the main character has imperfections or even psoriasis.

Get support for yourself

There’s nothing more painful than seeing your child suffer and having no control.  Seek support for yourself; try mindfulness, reach out to friends or join a forum.

Could childhood stress cause psoriasis?

Did you know that stressful experiences in your childhood may have increased your chances of developing psoriasis?

Known as ACEs, Adverse Childhood Experiences are anything but ace. They include physical, emotional and sexual abuse, witnessing domestic violence or growing up with household substance abuse.

It was always clear that such traumas could affect people as adults but now researchers across the globe are discovering that they have an even more powerful impact on your health as an adult.

Having a history of ACEs increases your risks of health-harming behaviours such as smoking, drinking or eating too much of the wrong stuff but what’s even more fascinating is that these experiences have an effect on the way the brain develops in childhood.

People who have a certain level of ACEs experience changes in their neurological, immunological and hormonal development. There seems to be something about being in threat mode frequently during childhood that wires the brain to be prepared for danger increasing tissue inflammation and resulting in long-term changes in immune response.  This leads to tissue damage and long-term wear and tear on the body.

There is convincing evidence that people who experience ACEs are at much higher risk for many long term health conditions like auto-immune disorders like psoriasis, cancer, lung disease, heart disease and mental health illness even when you’ve controlled for differences in lifestyle choices.  They can even shorten your life by 20 years and the more ACEs you have the higher your risk.

In one long term study (Danese et al, 2007), childhood abuse was associated with elevated CRP levels, white blood cell counts, and other markers of inflammation 20 years later.

But can we do anything about it?
Years of research have made the link indisputable but the next big challenge is what to do about it. Obviously prevention and early intervention is key but what about those people in adulthood whose traumas are in the past?

I have psoriasis and a fairly significant ACE score. Do I need to just accept that this is the way I developed or can I reverse things?  The research is still in it’s infancy.  We know we can help people cope with trauma but what we don’t know is whether that reverse the neurological and immunological changes?

Helping adults heal is the next big challenge.  The brain has plasticity and can change at any age, so perhaps meditation and mindfulness practice can help to improve things.

It’s also important to remember that whilst a higher score means your risk is higher, it doesn’t determine your future.  Many factors such as a loving parent, grandparent or supportive school teacher can promote resilience so that lots of people with high scores do very well indeed.

One final thing to think about: I developed psoriasis when I was 13 years. I did have adverse childhood experiences to contend with – but psoriasis was another enormous ACE to add to my load and now I wonder for me whether it all became a bit of a vicious circle.

If you want to know more, then watch this excellent TED talk: Nadine Burke Harris TED talk

or watch this informative short animation: ACEs // Public Health Network in Wales

You can score your own ACEs here: Take the ACE quiz


Danese A. et al (2007). Childhood maltreatment predicts adult inflammation in a life-course study. Proc Natl Acad Sci U S A; 104(4):1319-24.

So you’ve got psoriasis? Cheer up love, it could be worse

imageYou know logically there are far worse things to have than psoriasis.  A glance at the evening news will tell you there are hideous things happening to millions of people across the world at every moment.  But someone telling you that having psoriasis is not so bad by comparison does not make you want to put on your dancing shoes and throw a celebratory party.  It makes you want to throttle them. And then put on your dancing shoes to kick them when they’re down on the floor.

I’m not going to tell you to cheer up.  I’ve had psoriasis for over 30 years.  I know all about the soreness, the flaking, the pain, the embarrassment, (pause for breath), the restrictions to life, the unpleasant treatments, the uncertainty and the horrible out of control feeling it brings but I honestly believe you can be happy despite having this condition.  It’s just not as simple as someone telling you to look on the bright side because it could be worse.

There’s an exciting and developing field of psychology devoted to helping people feel positive and happy whatever their circumstances.  If you think of a scale with misery at one end and ecstasy on the other, traditionally a psychologist would aim to help someone move from the depression end to somewhere in the middle of the scale; a neutral point.  Recently psychologists have begun to focus on helping people move towards the happiness end of the scale instead of just aiming for an absence of low mood.

Positive psychology therapy involves techniques such as learning to savour the moment and connecting with other people and there is good scientific evidence that these strategies can help with clinical depression.  You can read more about these simple yet powerful techniques on the Action for Happiness website.

It would seem that being happy has more benefits than the simple joy it brings.  In the 1930s, a large group of Catholic nuns were required to write a 2-3 page autobiography before entering the convent and then went on to live very similarly structured lives.  Many years later psychologists discovered and analysed these autobiographies rating the nuns’ cheerfulness.  They discovered that the positive nuns lived longer by 10 years.  A whopping 54% of cheerful nuns reached the age of 94 years compared with only 15% of the least cheerful ones.  Evidence that it’s not only nice to be happy, it’s good for you too.

Living with psoriasis is not easy.  Often it feels like I’ve turned up to an elegant cocktail party in fancy dress by mistake.  Everyone else looks like they belong to the Kardashian clan and I’ve come as Hellboy.  Oh the shame of being the only guest to miss the ‘bring your flawless skin’ memo.

So yes, it could be worse and yes, it could be better.  The long and the short of it is I have psoriasis and there’s no cure.  I struggle with accepting that but I am determined to enjoy my life in spite of it.  I want to be happy.  I am more than skin.

Follow my blog for tips about coping with psoriasis.

The Shame of Psoriasis

What are people thinking about you when they look at you?

OMG how ugly
She looks dirty
That’s disgusting
I don’t want to go anywhere near him in case I catch it

It’s tough to live with those thoughts going around your head and little wonder we try to hide our skin and cover up.

People with psoriasis often rate other people’s reactions to their skin as the main difficulty with the condition.

But are you sure you’re always right about what people are thinking?

A psychology experiment carried out in 1980 took a group of women and made them up with fake scars. The women, who thought they were ‘disfigured’, then had a conversation with a stranger who knew nothing about the experiment. After the conversation, the disfigured women felt stigmatised. They were more aware of the stranger’s behaviours like staring and related this to their appearance. They thought the stranger was reacting negatively to the scar and this affected how favourably they rated the stranger. What women didn’t know was the experimenters had actually removed the scar before the conversation took place so any negative reaction to the (non-existent) scar was imagined. This study tells us that believing you look different heightens your awareness of other people’s behaviour and you are more likely to interpretate their behaviour as negatively related to your appearance – whether or not that is actually the case. Because of this, you are less likely to warm to strangers.

There’s no doubt some people are rude, unpleasant and insensitive. I’ve met a fair few of them. I’ve written about one particularly upsetting encounter here. But perhaps it’s not quite as bad as you think. Try some CBT and see if there is a different way of thinking?



Kleck RE and Strenta A (1980). Perceptions of the impact of negatively valued physical characteristics on social interaction. Journal of Personality and Social Psychology, 39 (5), 861-873.

Sun, Sand, Sea and Psoriasis


It’s beach weather and that can be very stressful for people with psoriasis. Whilst most people are thinking about sand castles and seashells, we are thinking about skin, skin, skin.

Our options for the beach are:
* Stay away
* Go but cover up
* Brave it in beach attire

Neither option is the right one and I have done all three at various times in my life. Here are my beach tips whether you decide to cover up or strip off.

1. Pick the right swimsuit. In my time I have worn long surf shorts with a tankini top and I also own a stylish modestkini (yes that is a thing!). I wear a wetsuit to swim in the sea which is quite sensible on the Welsh coast even when your skin is perfectly perfect.

2. Wear sunscreen. Whilst the UVB rays can be helpful, burning never is.

3. Try waterproof camouflage make-up. I spent a wonderful afternoon with a Red Cross camouflage make-up consultant and I came away with a prescription for my exact skin colour. The service is now provided by Changing Faces. I urge you to book yourself in and see what a good concealer can do.

4. Use a few windbreaks. It will give you privacy, as well as keep the sea breeze from chilling you.

5. Let your children/partner/beach buddy bury your legs in the sand. Cover your plaques, exfoliate and keep them entertained at the same time.

6. Be prepared for comments and questions so it doesn’t ruin your day if someone asks about your skin. Read this for more advice about dealing with unwanted attention.  This blog post might help too.

7.  Identify your thoughts that are making you feel anxious.  Try some CBT techniques to challenge them.