Brian Lehrschall is a government affairs specialist at the American Red Cross North Carolina. He is a patient with psoriasis: https://www.theeducatedpatient.com/view/how-glp-1-therapy-helped-brian-manage-psoriasis-and-diabetes 

Brian Lehrschall

Silent Weight of Psoriasis: Addressing Depression, Anxiety, Stigma in Care

In recognition of Psoriasis Awareness Month this August, 

 spoke with assistant professor of dermatology Eva Parker, MD, of Vanderbilt Health, pediatric dermatologist Carla Torres-Zegarra, MD, of Children’s Hospital Colorado, psychiatry-certified physician associate Tess Quesenberry, PA-C, CAQ-Psy, from Alpha Psychiatric Services, and several patients with 

Dermatologists often recognize psoriasis as merely a skin condition, marked by redness, scaling, and flare-ups. However, for the 8 million Americans living with it, the challenges stretch far beyond redness, scaling, and flare-ups.¹ What’s less visible—and often more difficult—is the emotional toll.

“The plaques of psoriasis are often in visible locations, knees, elbows. It can affect the hands. It can affect the face, the ears, the scalp, and extend onto the neck. And so, it can be hard for individuals with psoriasis, who have poorly controlled disease, to hide their skin lesions, and in public, that can be embarrassing. People stare,” Parker told 

. “There's often an assumption that if you have something on your skin, it's contagious. All of this can contribute to low self-esteem in our psoriasis patients, and that in turn, contributes to things like depression and anxiety.”

Patients with psoriasis are 1.5 times more likely to develop depression than the general population, and anxiety symptoms affect up to half of those diagnosed.² Research suggests that the inflammation in psoriasis, involving TH17 cells in the brain, may contribute to depressive symptoms.³

Feelings of self-consciousness and fear of stigma can leave patients isolated, self-conscious, or misunderstood. These psychosocial challenges ripple outward, affecting relationships, work, and quality of life.

Routine dermatology visits are an opportunity to do more than check plaques—they’re a chance to ask about mood, stress, and coping. Even a quick, structured screening can uncover depression or anxiety that might otherwise go unnoticed, allowing clinicians to intervene earlier with appropriate support.

Studies have also shown that personality traits or psychiatric disorders can influence how patients perceive their skin disease. For instance, patients with OCD may be more prone to skin picking, and those with borderline personality disorder may be more prone to self-harming behaviors.³

Psoriasis begins on the skin, but its impact runs much deeper. By addressing both the visible and invisible aspects of the disease, clinicians can help patients move closer to true healing—inside and out.

“As dermatologists, we get desensitized to skin disease because we see skin disease all day, and it is something that we see widespread disease, we see severe presentation, so it may not impact us in the same way as it impacts patients,” Parker said. “It's easy to forget that the disease itself is very stigmatizing, and it can be very alienating for patients…the number one thing we can do in treating our patients with psoriasis is to see them, to ask how their disease impacts them as an individual, and to make every effort we can to help them navigate what resources are available, especially if there's concomitant mental health illness.”

Brief descriptions of the speakers featured in this project are provided below:

Featured: Ayesha Patrick (top left), Carla Torres-Zegarra, MD (top right), Tess Quesenberry, PA-C, CAQ-Psy (bottom left), Eva Parker, MD (bottom right)

 Assistant professor of dermatology at Vanderbilt Health

 Psychiatric certified physician associate from Alpha Psychiatric Services

 Pediatric Dermatologist at Children’s Hospital Colorado and Associate Professor of Dermatology at the University of Colorado School of Medicine. Host of Pediatrias en Línea, the first podcast for Spanish speaking providers produced by Children's Hospital Colorado.

Relevant disclosures include UCB, Inc for Parker and Otsuka America Pharmaceutical, ITI, Inc, ABBVIE, Neurocrine Biosciences, Alkermes, Takeda Pharmaceuticals, Almatica Pharma, and Teva Pharmaceuticals for Quesenberry. Torres-Zegarra has no relevant reported disclosures.

Hedemann TL, Liu X, Kang CN, Husain MI. Associations between psoriasis and mental illness: an update for clinicians. 

. 2022;75:30-37. doi:10.1016/j.genhosppsych.2022.01.006

National Psoriasis Foundation. Psoriasis Statistics. www.psoriasis.org. Published December 21, 2022. 

https://www.psoriasis.org/psoriasis-statistics/

Jafferany M. Special Report: Psychodermatology: Bridging Dermatology and Psychiatry. 

. 2025;60(3). doi:https://doi.org/10.1176/appi.pn.2025.03.3.2

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Up to half of psoriasis patients report significant psychiatric symptoms, highlighting the importance of routine screening in practice.

Brian Lehrschall

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