The fact that psoriasis is a visible skin condition means that dealing with the stigma of it is an unfortunate and common occurrence for people living with the disease. While some people’s questions or comments may stem from innocent curiosity or an intention to help, they can still hurt. Other times, it’s much worse: People may make accusations about your cleanliness or wrongfully assume skin flares are contagious. You may also feel judged for using mobility aids, handicapped parking permits, and more.

A global study published in 2018 surveyed more than 8,000 people with moderate-to-severe psoriasis. Of the respondents, 84 percent reported experiencing discrimination or humiliation related to the disease.

Results from a study published in 2017 found that experiencing high levels of stigma around the disease was the most powerful predictor of depression in people with psoriasis.

Meanwhile, all of the misperceptions, judgment, and general anxiety about what others think can bring on more stress, which can make symptoms worse.

Stress has a bidirectional impact on psoriasis, explains Saakshi Khattri, MD, a dermatologist and rheumatologist, as well as an associate professor of dermatology at the Icahn School of Medicine at Mount Sinai Hospital in New York City. Stress of any kind can trigger a symptom flare, according to the NPF, and knowing about this association can lead to further stress. Psoriasis in and of itself is also stressful. Symptom management, frequent doctor’s visits, and worry about the effectiveness of your treatment can be stressful, says Dr. Khattri. All of this stress can trigger another flare, which can lead to more stress: “It’s sort of a chicken-and-egg situation,” she says.

Because psoriasis affects your appearance, you’ll undoubtedly need to have conversations with people in your life about your condition. You can tailor these conversations to the relationship you have with the person and what they need to know. Even if you feel intimidated at first, educating others about psoriasis and talking openly about what you’re experiencing can lift a weight off your shoulders.

“Having people around who know what it is will lessen the stress of having to explain what it is all the time,” says Khattri.

Letting people in can also help others be more understanding if you need to cancel plans because of a bad skin or joint flare or other symptoms, such as fatigue.

Aside from opening up to loved ones about your disease, consider joining a support group, which provides a chance to connect with others who understand firsthand exactly what you’re going through with psoriasis and psoriatic arthritis.

“It builds a community of like-minded people who are facing the same issues,” says Khattri. “Sharing stories can be powerful and make things more relatable. It helps to know you’re not alone.”

While managing dry, itchy, scaly patches from psoriasis, some people also start to experience joint pain, stiffness, and swelling caused by psoriatic arthritis. Left untreated, this can lead to deformities of the joints.

Not everyone with psoriasis will develop psoriatic arthritis, but this related condition is thought to occur in approximately 30 percent of people with psoriasis, according to the NPF. Psoriatic arthritis usually starts about 10 years after developing psoriasis, but some people may be diagnosed with psoriatic arthritis before — or even without — a psoriasis diagnosis.

If you have psoriasis and start to experience joint symptoms, reach out to your doctor right away. Chances are, you’ll get a referral to meet with a rheumatologist, a doctor who specializes in treating psoriatic arthritis.

Although receiving another diagnosis when you’re already managing psoriasis can further affect your mental well-being, know this: The lifestyle changes you’ve made to manage psoriasis — managing stress, eating a healthy diet, exercising, getting adequate sleep — can go a long way toward protecting your joints, too. More important, various medications with different mechanisms of action can treat both psoriasis and psoriatic arthritis. This should, in some ways, be reassuring, says Khattri.

Finding an effective treatment that controls psoriasis and psoriatic arthritis — minimizing or even clearing skin symptoms and relieving joint symptoms — can also go a long way toward improving your self-confidence, emotional health, and overall quality of life.