Psoriasis: 'the badge of shame'. A case report of a psychological intervention to reduce and potentially clear chronic skin disease.

The psychological effects of skin disorders have long been established. Most research on psychological interventions for people with skin disorders has focused predominantly on cognitive behavioural therapy (CBT); however, CBT is not appropriate for everyone. We assessed the benefits of a psychological intervention, using the principles of systemic family therapy (SFT). The key to SFT is the understanding of problems in the context of family and social relationships, and how reciprocal dynamics influence problems. Problems thus have a dual construction; they do not exist only within individuals but rather are a product of the interactions between people and wider systems, such as communities and cultures. This report focuses on the importance of practice-based evidence and the need for more research. A 46-year-old female with a 40-year history of psoriasis was referred for psychological therapy for feelings of shame and low self-esteem. Many medications, including biologics, had been tried previously with no success. Initially, the patient attended therapy alone; later, her husband and other family members joined her. Issues around her past, relationships, and personal beliefs/assumptions were explored. Over ten 50-min sessions, she was able to view her dynamics and relationships in a more helpful way. Her psoriasis cleared, reinforcing that it may have been caused by underlying psychological difficulties. Dermatologists need to work in a more holistic way to provide quality care to patients, meeting their psychological and dermatological needs. There is also a need to develop a broader evidence base and interventions for people with skin disorders.