The impact of psoriasis on the skin can be very visible. What is often not so apparent is the toll it can take on sufferers' experiences, feelings, and behaviors. Shelly, who developed psoriasis at the age of eleven, knows the emotional pain all too well. "I was often treated like an outcast," she recalls. "When other kids noticed the psoriasis on my arms, they thought it was contagious and didn't want to come near me. Some parents even told their kids to stay away from me."

For many years, Shelly struggled with feelings of shame, low self-esteem, isolation, and loss of self-confidence. "For me, the worst was seeing the fear it aroused in some people. After a while, I started to feel like I was a "freak" she says. These feelings carried over into adulthood. Shelly wore long sleeves to cover up her psoriasis, even on hot days. She avoided the beach. Socially, she had become so unsure of herself that she expected rejection. "I dated a few men who were emotionally abusive, and I just put up with it. I thought no one else would want me."

In her late twenties, Shelly decided to become more proactive with regard to her skin disease. "I was working as a preschool teacher and had done a good job hiding my psoriasis. Then one day at a gathering, one of the administrators caught a glimpse of my arm and seemed very alarmed. Shortly thereafter, I was fired for reasons that made no sense to me. I felt that it was because of the psoriasis." Driven by her emotional wounds, Shelly entered therapy and became involved in efforts to educate the public about psoriasis. "Having worked through the shame and humiliation, I was finally able to talk openly and confidently about my skin condition. The most beneficial thing for me has been working to eliminate fear, ignorance, and insensitivity in others" she says.

Experiences like Shelly's are not uncommon among sufferers of psoriasis and other chronic skin conditions. Feelings of sadness, helplessness, guilt, anger, and low self-esteem may surface as a person struggles to cope with the disease. Frustration can arise from lack of understanding about the disease or the difficulty finding an effective treatment. Sufferers may not have anyone who can understand the challenges that psoriasis brings to their lives. These are completely normal responses, but sometimes they lead to depression.

Not everyone with a chronic skin disease needs help developing emotional coping strategies, but many do, especially if their skin condition is severe. Emotional and social coping varies among individuals and is often related to personality type. Some people are less self-conscious than others, or better able to shrug off inquistive looks, insensitive comments or rejection. Here are some effective coping strategies.