"Ugh…how do you catch that?" - A qualitative study of the impact of psoriasis on social interactions.

Background: Psoriasis is associated with significant psychological disability. Due to the visibility of skin lesions, patients with psoriasis commonly report experiences of stigmatisation and public rejection.

Objectives: We aimed to gain insight into individuals' experiences of the extent, type and management of psoriasis-related social interactions, and the long-term impact on social functioning.

Methods: Qualitative, semi-structured interviews (n=24) were used to elicit the views and experiences of psoriasis patients. Data were analysed using inductive thematic analysis.

Results: Analysis produced four overarching themes: 1) 'varied experiences of psoriasis-related interactions'; 2) 'threat to sense of self' 3) 'preserving social connections' and; 4) 'wasted opportunities for positive interactions'. Psoriasis had a significant impact on social interactions. Although overtly negative reactions were rare, even supportive comments were appraised negatively by patients as an unwanted reminder of the condition. Patients' behaviours within social situations were motivated by desires to minimise further attention, preserve self-identity and protect existing social relationships. Periods of social avoidance contributed to a damaged sense of self and decreased confidence in communication skills.

Conclusions: Living with psoriasis may present unique social challenges. Even when the skin is well controlled clinically, patients may struggle to re-engage socially. The damage to the sense of self and decreased confidence in communication skills suggests that psychological therapies such as Acceptance and Commitment Therapy and social skills training may be beneficial.