Second Case - Emotions and Depression

The second case history concerns a young woman who developed psoriasis before the age of thirty.  Unlike many sufferers of the disease, she had no relatives that experienced any type of lesion.  Like many Americans, she assumed that the doctors would have some treatment or medication that would make the unsightly symptoms disappear within a week or two.  Instead, they prescribed a coal tar treatment and phototherapy.  Translated, that meant to apply a material that smelled like road pavement and go bake in the hot sun.  Not only was this uncomfortable and smelly, it did not seem like modern medicine, but rather some home remedy from the back woods.  They also told her that the disease was chronic, and though this flare up would likely disappear with time and treatment, additional flare-ups may happen at any time. The inflamed areas caused discomfort and itching, but the worst aspect of the disease was the toll it took on her emotions.  The inflamed areas were a cause for personal embarrassment and a tendency toward depression, but even worse was the reaction of other people, whether close friends or people standing in line at the grocery store.   The bright red color of the psoriasis patches seemed to indicate either that there was a possibility the problem was contagious, or at least that personal hygiene was a strong contributing factor.  It gave her a feeling of how lepers might have felt a hundred years ago or so.   This possibility of rejection every time she planned to go out started to create significant anxiety, which in turn caused great stress in her life.  As explained in an earlier section, stress is a factor that can make the inflamed areas worse or more persistent and resistant to treatment. During the first few months after the diagnosis of psoriasis, she started collecting some of the comments made by friends, acquaintances, or co-workers.  Many of these were said with care, or at least interest.  Some assumptions were that the inflammation was due to poor nutrition, insufficient hygiene, some contagious skin condition like a very intense case of ringworm, or a physical manifestation of an unusually nervous person.   After a number of months she decided not to fight anymore, and instead just avoid the issue by covering up the larger and more noticeable areas of inflammation. Since the worst areas were on her legs, covering those was not particularly difficult to do.  However, selecting a wardrobe in order to avoid the stares and comments of other people can be a depressing endeavor.  In addition to a large number of slacks, opaque stockings and leg makeup solved the problem of hiding the largest of the lesions.    Years went by. After a very long time, the inflammation reduced markedly.  The scaly lesions that had become part of everyday life became much less noticeable, and most of them disappeared entirely.  Once that improvement became noticeable, she began again to experiment with treatments to help her skin improve.  This time treatment with moisturizers and limited sun exposure had a good effect.  Finally, things had improved to the point that clothing like skirts and shorts could be worn again. This may seem a rather trivial result, but this case history is to indicate the huge mental and emotional toll that the evidence of psoriasis can have on a patient.   This story also proves that telling the general public about psoriasis is a very important thing to do.  Perhaps the change in clothing would have happened anyway even if people didn’t comment on or shy away from the lesions on her legs, but their reaction cemented the decision and was a significant emotional toll.   The freedom that she felt once her legs were healed and it wasn’t necessary to cover them up was, as the commercial says, priceless.   Imagine the feeling after fifteen years of hiding the lesions behind slacks, makeup, or tights. The final part of this case history is also emotional mixed with some resolve.  Once the lesions had disappeared, depression and fear came in.  Why?  The fear that another flare up might occur led to part of the depression, and the other aspect was grieving for the fifteen years of hiding.  Out of this mix of emotions came a resolve to live life normally and ignore the untutored comments of other people.  Yes, there were additional flare-ups, and yes, people who saw them still said unknowingly unkind remarks, or moved away from her in public places.  Dealing with the flood of emotions that psoriasis can bring may be more difficult than the treatment for the lesions.