People with psoriasis, a long-lasting autoimmune skin condition, often experience another complication: mental health concerns.

In fact, having both psoriasis and mental health conditions is so common that it’s expected, says Dr. Anthony Fernandez, MD, PhD, director of medical and inpatient dermatology at the Cleveland Clinic.

The connection between psoriasis and mental health is multilayered. At the simplest level, says Dr. Fernandez, psoriasis’ red, silvery patches can lead people to feel inherently flawed.

Research has found that individuals with psoriasis can experience a sinking self-esteem (along with more anger).

In many cases, the location of the psoriasis can have a more profound effect on an individual’s self-esteem, such as having patches on the face or genitals, says Dr. Fernandez.

Anxiety, depression, and other mental health conditions are also prevalent in people with psoriasis.

Men, in particular, might significantly struggle because they generally tend to stay silent about mental health conditions.

They may feel embarrassed about sharing or worried about appearing weak. This often results in men keeping their anxiety and depression to themselves, which can lead to these conditions flourishing.

Large-scale research all over the world has corroborated the well-known connection between psoriasis and mental health.

For instance, a 2016 study found a 16.5 percent prevalence of depression in Americans with psoriasis, regardless of the severity of their psoriasis.

A study in South Korea found that people with psoriasis were twice as likely to have depression, anxiety disorders, and sleeping disorders than individuals without psoriasis.

Research out of Denmark also found that over the course of 5 years, 2.6 percent of people with psoriasis developed mental health disorders, including depression, anxiety, and bipolar disorder.

Within 10 years, almost 5 percent developed these disorders.

While psoriasis and mental health are interconnected, there’s no clear-cut, definitive reason that explains exactly how. Instead, many reasons and underlying mechanisms have been implicated.

For example, according to this 2016 review, anxiety may result from:

  • psoriasis symptoms, such as chronic itching
  • its appearance on the skin and associated stigma
  • lack of social support

Worrying about psoriasis and particularly how others perceive you can trigger the stress system, especially your amygdala, says Dr. Harry Barry, MD, a physician who specializes in mental health and author of “Emotional Healing: How to Put Yourself Back Together Again.”

This, in turn, activates the release of stress hormones, such as cortisol, initiating a vicious cycle, says Dr. Barry. Stress triggers psoriasis flare-ups. Flare-ups then further stress you out.

According to the above 2016 review, stigma and appearance have also been linked to depression, along with feeling dissatisfied with psoriasis treatment.

In some cases, Dr. Fernandez notes that mental health conditions may worsen when people with psoriasis can’t engage in recreational activities they enjoy because of pain.

Connections are also biological.

For example, depression and psoriasis are both associated with higher levels of pro-inflammatory cytokines, including tumor necrosis factor (TNF), interleukin (IL)-1B, and IL-6. These proteins stimulate the body’s immune response.

Consequently, the inflammatory process may play a role in both diseases with different theories explaining the association, as this 2017 review notes.

Depression and psoriasis may have another underlying mechanism in common.

According to another 2016 review, depression can lead to reduced levels of melatonin, which has anti-inflammatory effects.

Similarly, individuals with skin disorders, including psoriasis, may have abnormally low levels of melatonin.

Psoriasis treatment often improves mental health disorders.

According to Dr. Fernandez, psoriasis treatment effectively clears up significant portions of psoriasis, which leads to feeling healthy and confident.

Because of the reduction in pain, those being treated for the skin condition are also able to participate in important-to-them physical activities.

It’s also critical to pinpoint the specific reasons you’re having a hard time, because most can be resolved, says Dr. Fernandez.

For example, to resolve persistent itching that interferes with sleep, doctors can prescribe anti-itch moisturizers, suggest getting more sunlight, and refer you to a sleep specialist, he says.

When treatment adjustments don’t reduce mental health disorders, your doctor can refer you to a mental health specialist for an evaluation.

Anxiety and depression (and other mental health conditions) are highly treatable with medication and therapy.

Again, given the multilayered and complex connections between psoriasis and mental health, know that it’s common to experience anxiety, depression, and other disorders.

Talk to your doctor about your symptoms and experiences.

In addition, here are some positive actions you can take to help manage your mental health:

Identify how psoriasis is affecting you

While you might not feel comfortable identifying your emotions, doing so is incredibly helpful for feeling better. Take some time to figure out your specific feelings, says Dr. Barry.

Here are some questions to help with that process:

  • Do you feel anxious about your appearance?
  • Do you worry about what others will think of your appearance?
  • Are you upset that you can’t participate in your favorite activities because of pain?
  • How do you feel during flare-ups?
  • Do you avoid social activities because of psoriasis?
  • Do you find yourself experiencing symptoms of anxiety or depression even though your psoriasis is well managed?

As you start to understand the mental health effects of psoriasis, consider making an appointment with a therapist to get an evaluation.

Whether you’re feeling upset or experiencing depression, working with a therapist can help you reduce symptoms and get better faster.

Aim for 8 hours of sleep

While everyone’s sleep needs will differ, in general, getting 8 hours is a good rule of thumb. During sleep, our brains and bodies repair themselves, says Dr. Barry.

“It is also the period when our emotions are detached from our contextual memories, so vital in reducing stress, anxiety, and depression,” he adds.

Prioritize exercise

Exercise is another tool that helps you reduce stress and anxiety and boost your mood. It also aids in reducing inflammation.

Dr. Barry recommends 30 minutes of brisk exercise every day. Experiment with different activities to find what you enjoy.

Add other healthy activities

Think about other ways you can reduce stress and feel better every day. For example, you might:

  • listen to a guided practice using a meditation app
  • take frequent breaks during work to listen to music or stretch your body
  • practice deep breathing throughout the day
  • add fruits and vegetables to your snacks and meals

Challenge unhelpful beliefs

You may be holding onto beliefs that boost your anxiety and depression, such as “Because I have psoriasis, I am ugly, weird, or unlovable,” says Dr. Barry.

To challenge these beliefs, start by paying attention to the thoughts running through your mind every day. Then examine the unhelpful ones and replace them with a healthier outlook that supports you.

For example, according to Dr. Barry, “Can a person be defined as weird, ugly, or unlovable simply because they have a common skin condition such as psoriasis?” If that’s the case, then everyone with any medical or skin condition would be all those things.

Instead, you might adopt this much healthier, more accurate belief: “I am not my psoriasis. I’m a unique human being, who happens to have this condition.”

It’s also helpful, says Dr. Barry, to remember that people are more focused on themselves than anyone else and actually notice very little — including your psoriasis.

“How many of us for example [remember] what the last five people we met were wearing. The answer is very few! So too with signs of psoriasis.”

Just talk about it

Of course, if you’re still concerned about others’ perceptions (or anything else), talk with a mental health professional.

Remember, mental health concerns and conditions are common in people with psoriasis. You’re absolutely not alone.

While discussing your feelings isn’t easy or comfortable, getting the right treatment can help change your life.

The first step is to be honest about what’s going on.