Non-clinical psoriasis issues pose another hurdle for sufferers

San Diego - Presenters at the National Psoriasis Foundation's (NPF) 2004 National Conference here last month addressed issues that offer an unprecedented opportunity for dermatologists to partner with and offer hope to patients with psoriasis.

Touch, compassion, partnership According to clinical psychologist Stephen Rapp, Ph.D., psoriasis interferes with intimacy in several ways.

"The pain and physical discomfort of psoriasis will interfere when people want to maximize pleasure of intimacy," he says.

Another occurs when the psoriatic person's partner is put off by the appearance and feel of skin when lesions are present.

"Sexual satisfaction is, in part, derived through touch, so anything that interferes with the pleasurable sensations of touch creates a problem," Dr. Rapp says.

A third is the self-consciousness created by psoriasis.

"People differ in how self-conscious they are, but psoriasis may be a significant factor in creating self-consciousness because the lesions are disfiguring and conspicuous."

A fourth occurs when the psoriatic person believes his or her partner is put off by the appearance or feel of the lesions, even though the partner is not put off.

"This creates anxiety in the person with psoriasis, and anxiety is what you don't want when trying to have intimate pleasure," he explains.

Dr. Rapp, whose research includes adjustment to psoriasis and other dermatologic illnesses, practices in the department of psychiatry at Wake Forest University Baptist Medical Center, Winston-Salem, N.C. He is also professor of psychiatry and behavioral medicine, and of dermatology at Wake Forest University School of Medicine.

Less complex According to Dr. Rapp, intimacy is less complex with married than with single people with psoriasis.

"If you have a stable relationship, a psoriatic patient has crossed bridges that a single person has not," he says. "In a good marriage, negatives that arise are counterbalanced by positives that the partner already sees in the patient. And married couples generally talk more freely about how they want to 'adjust the dance' so it is more pleasurable and less painful.

"What I hear from single patients, almost universally, is that as soon as they start feeling attraction to someone, they start to wonder when to tell (their potential partners) about their psoriasis," Dr. Rapp continues. "Even if they don't have active flares, they are concerned that their potential partner has 'got to know.' Then all the fears about rejection come along."