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Psoriasis (young people)

Psoriasis and different areas of skin: where on the body?

Psoriasis can affect skin anywhere on the body. Some people we talked to had psoriasis only in one area, such as the feet for Zara. Others had psoriasis on lots of different parts of their body at various times. This includes the subtypes of nail psoriasis and scalp psoriasis.
 

Simon talks about the parts of his body where he’s had psoriasis.

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Age at interview: 22
Sex: Male
Age at diagnosis: 17
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It did start on my head and I remember it was on the back of my head right here and it sort of spread. Now it’s covered up about a third of my scalp and about half of my forehead. The first affected spots on my face and I’ll show you one it started breaking out last year on my arm and it used to be that big [demonstrates 10p size area] when it started to break out. So it started off there and just around January this year it started to appear on my back in little patches, about as big as a 10p coin. And also I’ve got, started to get them on my legs. Got one on the inside of my knee and my calf and on the, on my outer thigh. It spreads and it’s gonna keep spreading. Psoriasis is a chronic thing.
 
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Abbie talks about the body parts affected, such as her legs where she gets big psoriasis plaques.

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Age at interview: 20
Sex: Female
Age at diagnosis: 10
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So when I was younger it mostly just affected my knees a little bit, my elbows and mostly my scalp, and that was the worst part especially around my ears and around the bottom which obviously wasn’t the nicest, and then that kind of cleared up. Mostly a lot I get around my ears and in my ears and then elbows, they tend to get it quite a lot, and then I've had it on my legs quite a lot, so from top to bottom, but in bigger patches, and my knees.

It's also when you get big patches on different parts of your skin was the hardest to be able to tackle cos my leg, over the last one or two years, it was the biggest cos it went from my knee down to about my ankle, and that was just one straight patch down. So that was the more difficult one to be able to treat cos as much as I'd moisturise it, it was so big you couldn’t -, trying to see the difference in it or when it would go down it wasn’t -, you couldn’t really tell.
People often had particular concerns based on where their psoriasis was located. Concerns about the practical difficulties of managing their psoriasis, like applying topical steroids to the back or scalp, were common. There are also emotional aspects and having psoriasis on visible parts of the body made some people self-conscious. Jack says the psoriasis on his face is his main concern and other body parts affected are “secondary”. 

Psoriasis on the scalp 

Many people we talked to had first developed a patch of psoriasis on their scalp (see also about psoriasis types). Skin flaking meant that they often thought it was dandruff to begin with. Louie found it annoying when people assumed he had dandruff, Abbie remembers being teased at school about this and Sofia’s peers also thought she had head lice (“nits”).
 

Steven thinks it’s easier to apply treatments to his scalp with shorter hair, but doesn’t want this to determine his look too much.

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Age at interview: 22
Sex: Male
Age at diagnosis: 14
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It has affected my haircuts a little bit, I suppose. Because I tend, from having the treatment like that, from having, applying treatment I have it cut a bit shorter to try like get it easier. In fact, I should really go back and have it cut again. I didn't have it cut short enough last time. But then I wouldn't have like skin haircut, like all off, like bald, sort of thing. But the nurse did say to me like, “Oh that’s the best way you’ll get it to your scalp – just go have your hair all cut off”. I was like, ‘awrr, okay’. So, yeah. 

Could you say a little bit about why you wouldn't go for that haircut?

Doesn't suit me. That’s like the number one thing, like it looks horrible. I had it cut really short a few years ago. It wasn’t good. I suppose if things were really bad and we were, I was having light therapy or something like that and she said to me, the nurse said to me, “You’d have it cut really short then”. Then I would do. I’d like push that aside. Everyone says, it’s quite a big thing – your hair and having it cut short and y’know. And I think if I had to and it would really helped then yeah. But at the moment, I haven't done it because it’s not a help and it looks horrible if I have it done, so. It doesn't suit me [laughs]. 
Having psoriasis on the scalp can have an effect on hair-care, cuts, styling and dyeing. Lucy’s scalp gets itchy if she doesn’t wash it every day but says it’s a “faff” with long hair. Steven gels his hair up to reduce skin flakes dropping from his scalp. Jack finds getting his hair cut “awkward” and Lola’s mum cuts her hair as she’s too embarrassed to go to a hairdresser. Simon thought he shouldn’t ever dye his hair again, even if the psoriasis on his scalp cleared up. Others continued to dye their hair – Abbie found it stings her skin though and Megan buys special hair dyeing products which contain fewer chemicals. 

Psoriasis on the face/neck

Psoriasis on the face and neck can be difficult because it’s so visible. Lola said having patches on her face was the first time she realised how big an impact psoriasis can have emotionally. Adam remembers being “mortified” at school when a teacher made a comment about him having something on his face without realising it was psoriasis. Damini found it uncomfortable socialising and making eye contact with others when she had psoriasis around her eyebrows. Jack said it was tough having psoriasis on his face whilst at university because he was constantly meeting new people.

Some people used make-up and hair styling to cover psoriasis on their faces and necks. Adam sometimes used concealer for nights out. Ella said skin flaking makes psoriasis difficult to cover and make-up can make it “more obvious”. Damini used to wear her hair down a lot to cover up the psoriasis on the back of her ears. She also wore glasses and a scarf because she “felt better the more covered up I was”. Lucy, Damini and Ella said having a fringe can help cover psoriasis on the face. 

For those who shaved their faces, having psoriasis could make this more difficult. However, Simon found his psoriasis skin was less prone to bleeding.
 

Lucy finds wearing make-up on her face and body boosts her confidence.

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Age at interview: 24
Sex: Female
Age at diagnosis: 11
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And then make-up and I mean, I completely respect people who don’t wear makeup. I respect people who wear loads of make-up, fake tan, whatever. But for me, personally, I love make-up and I really do think make-up is a way, not just to cover it up, but to give me confidence. Like I wouldn’t feel confident going out, you know, without make-up on. And even, not just make-up on my face, but for my prom, in Year 11, I had this beautiful floor length dress, but it was quite a low back. And I had quite a lot of psoriasis on my back and I thought ‘what am I gonna do?’ And me and my Mam researched sort of like concealers and stuff. And we found this stage make-up. And it was brilliant. And it was, it was y’know, the same colour as my skin and we managed to like blend it all in. And it looked great and I felt so much more confident with that on and I just think, ‘why not?’
 

The redness on Louis’ face drew unwanted attention from others. It became easier for him to explain once he had a diagnosis of psoriasis.

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Age at interview: 21
Sex: Male
Age at diagnosis: 18
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Obviously psoriasis isn't particularly a good-looking thing to have on your skin. Very like red, angry, blotchy. And when it started on my arms and on my chest, that wasn't so bad because people don't see it day to day, but when it started coming up my neck and onto my face, then people would say, "Oh Louis, what's that on your face? What-, like what's going on?" And at the start that was a bit [sigh], that was a bit irritating, but I think you get used to that quite quickly. I think, especially once I knew it was psoriasis, I could say, "Oh, got this, don't know how long it'll be there for, hopefully it'll go away, that’s effectively it." But before it was sort of confirmed I had psoriasis, I had to sort of say, "Well I've got a rash, don't really know what it is, don't know what's going to happen to it." So that was-, that was a bit more difficult saying, "I don't know what it is, it's just something that's there." 
 

Simon finds it difficult to cover up psoriasis on the scalp and face. Different aspects of his life have been affected by feeling self-conscious.

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Age at interview: 22
Sex: Male
Age at diagnosis: 17
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I think the self-esteem has really come, comes from a, from the psoriasis itself. Especially when it comes to scalp because at the end of the day you can cover your arm up, you can cover your back up, you can cover almost every other parts of your body, but on your face and your scalp it’s not really as possible even if you wear a hood because at the end of the day it will still flake out and especially when I was a teenager, I used to wear a lot of dark clothes, so if the skin would flake really bad and it would fall onto your clothes it would look like a seriously bad case of dandruff. And especially when you’re going through sixth form at school where everyone is in sort of a hormone stage where everyone’s got their own cliques and so on and so forth, you do become, feel like an easy target because of your skin condition. It almost makes me, you feel like an outcast. There’s also other problems like if you’re going out like to have a drink with friends or if you’re even just meeting someone for a date or whatever you do think, “Oh, what am I going to do about my psoriasis? Will people think I look like a leper or something?” It’s really stressful to really think about, but which it does end up giving you sort of a really nasty cycle to live through because you don’t want the psoriasis so you do try to keep your stress down, but then like – it’s there. It, it’s sort of hard for me to explain but it’s there, you, everyone can see it clear as day. Some people might think that it looks like a burn. And which you can come up with some excuses it doesn’t really work when it starts getting into, into, onto a table or so on and it becomes really, really nasty to look at. 
Psoriasis on the ‘trunk’ (e.g. torso, shoulders, chest, back), arms and legs

Although easier for most people to cover on a daily basis, psoriasis on the ‘trunk’, arms and legs can be tricky. It can restrict movement and flexibility, as it did for Carys who had plaques on her stomach which cracked when she moved at work. Megan’s psoriasis on her arms and knees sometimes made it painful to bend and walk. Some clothing and fabric could irritate the skin and make it itchier. Megan and Lucy found wearing tights a problem. Lola struggled to stop herself picking at her psoriasis when she could see it on her arms. A few people had psoriasis on their armpits, which deodorant sometimes irritated.
 

Hannah looked into alternative deodorants when she had psoriasis on her armpits.

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Age at interview: 24
Sex: Female
Age at diagnosis: 16
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Deodorant affected me really badly, so I had psoriasis on my underarms so I was, and like all the stuff, that are kind of aluminium based deodorants like just wreaked havoc and made the situation so much worse. I mean if I wore deodorant, a normal deodorant, the next day I would visible see that my psoriasis was about ten times worse under my underarms and red and kind of hurting. So I eventually had to give up all together with normal deodorants and try to use some natural ones which I feel like probably aren't industrials strengths, so don't really work in the same way. But I found coconut oil really, really effective with, like as a deodorant and it's kind of stopped me sweating as much, it stopped like any smell. And it's really, really worked for me. That, sometimes coconut oil mixed with baking powder, which is something that I read online, so these, there are all of these kind of natural things online that people talk about and some things won't work for you and then some things really will and you'll, you'll wonder how you survived without them. So now like I use coconut oil all the time on my underarms and it's really helped. And then like I'll use sometimes natural deodorants as well that I’ve found like there's salt based one's that use like salt to-, kind of like a rock of salt and you rub that and you have to like kind of wet your underarms first. There are other ones that have like tea tree in them and other things to kind of like sooth, but also like to completely give it a better smell. But obviously nothing that's like antiperspirant because the idea of an antiperspirant in itself is like not a good thing to kind of stop yourself from perspiring that can of, that-, anything that has that in it can affect your skin badly I think if it's sensitive or if you have psoriasis.
Psoriasis on the trunk, arms and legs made some people feel self-conscious. Hannah sometimes used make-up to disguise patches on her arms and legs. Both men and women talked about having restricted clothing choices because they didn’t want others to see their psoriasis. This was especially a concern during the summer, swimming and dressing up for nights out or special occasions.
 

Abbie’s job means being outdoors a lot in the summer but she wasn’t confident showing psoriasis on her legs.

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Age at interview: 20
Sex: Female
Age at diagnosis: 10
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Especially working here, especially being outside we’d…it's easier to wear shorts in the summer especially when it's really warm, but I'd always try and avoid wearing shorts and go for trousers just because I feel comfortable, more comfortable, than having to get my legs out especially going out in dresses. I didn’t really want that – I'd have to make sure I wore tights but I'd still feel conscious that you could see it. And I've even had, when I've -, it's been so hot working over the last few years and I've had to wear shorts working with smaller children and they ask you questions about it and it just doesn’t really feel the greatest and then like with my sister's wedding she wanted short bridesmaids dresses but I told her that I wouldn’t and I couldn’t wear one. Obviously it's now cleared which meant we could have worn one but I told her no I wouldn’t because I didn’t wanna look like that, have my legs out doing wedding photos or anything like that.
 

Steven says having psoriasis on his shoulders and back “wasn’t such a big deal for me because it wasn’t really visible”, but it affected going swimming.

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Age at interview: 22
Sex: Male
Age at diagnosis: 14
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Then I have my back, which wasn’t dreadful, because I didn't really show it off. There was a point where I didn't really want to go swimming, because I did feel that people would, I think, arms and legs was one thing – I could kinda like cope with that. I had longer swim shorts that didn't really cover it but, it kind of like detracted from it. You could just kind of like pretend it wasn’t there. And arms was fine, but when I had it on my back and sides it really was a bit more-. I did go swimming. But I felt quite conscious about it and I knew it was there and I knew that, you kind of clock people looking. And, I didn't want to let them get to me at all, because I thought, do you know what, I’m not gonna let it stop me doing anything. I wanna go swimming, I’m going swimming. But, I did notice like people. And that’s quite difficult. I had to be like ‘pretend they’re not there, just carry on’ sort of thing. 
 

Ella’s choice of clothing has been shaped by having psoriasis on her chest.

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Age at interview: 16
Sex: Female
Age at diagnosis: 3
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All my clothes are all high necked which is fine because I can wear like vests with a high neck which is quite fashionable at the moment, which is fine. But I would just like that option to have-, to wear something a little bit more low cut, but I really don’t feel comfortable, and even if I didn’t have any psoriasis there I would still not feel very comfortable with like having my chest-. I don’t know, I think it's just because I've had psoriasis there for such a long time that just like subconsciously , subconsciously I just think, 'oh no you can't wear anything low cut, you shouldn’t.' Even if there isn’t anything there I just-, that’s something that I just think automatically. And then if there's something-, if I wanna wear-, if it's a really hot day and I want to wear a vest or something and I have psoriasis like underneath my arms or like on my shoulders, or like, yeah, or like on my shoulders or my upper chest, then like I can't wear that sort of thing and it's like I'll be wearing a like a cardigan or a hoody all day which I don’t want to cos it might get really, really hot but I just don’t want to take it off because I have psoriasis there. 
Some people felt strongly that they shouldn’t have to cover up their psoriasis (and that fresh air/sun might help), but also they didn’t want others to make comments or ask questions. Steven described this as “a balancing act”. It could be nerve-wracking wearing clothes which showed psoriasis. Lucy remembers being asked about her skin by a stranger on a bus when she was wearing a halter neck top. Simon used to wear a jacket all the time, including in hot weather. Abbie was “fed up” with wearing trousers and tights to cover the psoriasis up on her legs but didn’t feel she had other options. A few people thought their clothing choices made them ‘stand out’ more. Carys remembers an outfit for a party which she liked but thinks “it was obvious that there was something that I was hiding”.
 

A few summers ago, Megan covered up so others couldn’t see her psoriasis.

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Age at interview: 16
Sex: Female
Age at diagnosis: 7
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I decided all through the summer I'd wear jeans or tracky bottoms, and I'd wear long sleeved t-shirts and jumpers. Even if I was really hot I'd still wear them, like I didn’t want people to see my skin, so I'd do it anyway. And then, as my skin got better I'd like wear whatever I felt comfortable in. But when my skin was really bad in July, I decided that it was best if I just covered it up, so no one saw it. So, I'd just, I'd go out with my mum like shopping, but I'd wear so many layers, and you'd see loads of people like in shorts and t-shirts and everything, and then there'd be me in like jeans and like a long sleeved t-shirt and a jumper.

So, what was that like for you if you have to go out with sort of more clothes on, more layers?

It would, it like made me feel really hot, and like I wanted to take it off – but it made me feel a bit better, like no-one can see my skin so I'm not getting judged; and I guess that’s the thing that kept me wanting to do it. Like, I'm not getting judged and I'm quite happy like that. I don’t want to be judged by people because that makes my self-confidence even worse. And just as my self-confidence was getting better, it just went straight back down again.
 

Damini wore long sleeved tops when she had visible psoriasis.

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Age at interview: 21
Sex: Female
Age at diagnosis: 4
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So my recent flare-up, when that came up, it was just always long sleeves. I’d wear scarves. As it started going away, I slowly started wearing short sleeves again. When I did have my outbreak I wouldn’t even wear short sleeves in the house. It would always be covered up. So, first of all, I started wearing short sleeves in the house just to slowly get my confidence back. And then, one day, I had to pop into town and I thought, I’ll just try going in a short sleeved top, see how I felt. It was hard to start off with. But then I realised no-one even looked at me. So I just thought, well maybe it looks better than I actually think it is. And I think that just boosted my confidence.
 

Ella’s less worried about her clothing choices now she feels in control of her psoriasis.

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Age at interview: 16
Sex: Female
Age at diagnosis: 3
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And I think now I'm sort of getting like I don’t really care like about that, but like especially when I was at-, a bit younger like early teenager, like I wouldn’t want to wear anything that wasn’t long sleeve or three quarter length sleeve, or anything like that. 

Why do you think that change might be happening for you whereby you're feeling a little bit more comfortable?

Yeah. I think it's because my psoriasis is fairly under control now. Like I am- I put my creams on every single night so they're not-, so my psoriasis isn’t as bad, but I think it's also with my attitude to it as well. Like I don’t really care if people can see the psoriasis on the back of my elbows, like that’s not somewhere people like will automatically look, so I'm fine with wearing t-shirts and things. But I think also where my psoriasis is it's quite easy to cover up. Even if I wanted to wear a crop top or something like that, like it would be fine; like I have no psoriasis there so people wouldn’t be able to see it. But definitely like I do have some psoriasis right here [points to chest] at the moment, so I wouldn’t wear anything that was maybe a little bit more low cut or anything. 
Body hair removal was talked about by some of the young women. Some said there were times when they didn’t shave because it was too uncomfortable. Abbie found cuts from shaving on her legs would scab and become new patches of psoriasis. Damini prefers waxing.
 

Lucy’s psoriasis makes shaving her legs difficult. She finds it helps to use an emollient as a shaving foam.

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Age at interview: 24
Sex: Female
Age at diagnosis: 11
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Sometimes my skin gets really really bad from shaving and my doctor said, last year, my skin got really bad. And we went on holiday and I couldn’t go in the sea or in the pool, cos it was so bad. I was so frustrated. My doctor said, “Don’t shave.” But as a woman, you don’t, you know, you want to shave your legs don’t you, especially in the summer. So you know, sometimes I use Veet, which is really good, but it’s messy and quite smelly and but I think, you know, I used to use like, I used to just get cheap razors, which I shouldn’t have done, cos it, it knacks, it really really damages my skin. So what I do now is get like good razors and, good disposable razors, but use a new one every single time. Cos it’s easy not to, it’s easy not to use it a few times in the shower, but it’s not worth it, cos, cos that’s how your legs will get, well, that’s how my legs will get really bad and. So as long as I shave carefully and properly I can do it and it’s fine on my skin. But the doctor gave me this really good cream and I can’t remember what it was called, but it’s great. And he said he shaves his face with it. So it’s this moisturising cream that I put on my legs instead of using like shaving foam, I use that. And then shave against the hair growth, like not, shave the same way as the hair growth rather than like against it, so there isn’t that much friction. And my legs are so smooth afterwards with this lovely moisturiser. So there are ways of doing it. Cos, I wouldn’t like to walk around in the summer with hairy legs [laughs]. There are ways of doing it. But I just have to be really careful, cos I haven’t in the past and my skin’s been really bad because of it.
Psoriasis on the hands and feet

The hands and feet are often visible and in constant use. Hannah and Simon also had nail psoriasis and Zara’s toe nails fell off when she was little.

For some with psoriasis on their feet, finding comfortable shoes can be difficult. Russell said he had to a buy “an emergency pair of flip flops” when he had a big flare-up. Zara sometimes feels self-conscious taking her shoes off because they’re prone to infections which make them weep and smell. It’s painful for Zara when doctors spread her toes apart to examine the psoriasis.

Applying treatments like steroid cream to the hands and feet can be impractical. Russell finds it time-consuming having to wait for the creams to absorb. Some people found wearing socks helped topical treatments stay on their feet and Zara had some silk ones which helped reduce the friction on her skin.
 

Russell says he “never felt particularly embarrassed” about psoriasis but sometimes wondered what people thought when they saw his hands.

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Age at interview: 20
Sex: Male
Age at diagnosis: 19
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Occasionally I’d feel a bit sort of sheepish about my hands because you kind of, because it looks so flaky and it looks, I think it looks worse than it actually is. so if you're kind of talking to someone or you have to shake hands or something you’re a little bit self-conscious because you’re thinking “Oh what are people going to think of me”, I’ve got horrible dry flaky hands, they’re going to think that I don’t take care of myself or that I’m not a very healthy person or I’m not a clean person and obviously the irony is that you’re, well, it’s not related to any of those things, I shower every day, I’m clean and what not and there’s nothing you can really, there was nothing I did to bring it on. but nobody else knows that and it’s not something you bring up in conversation like justifying that you are a clean person or justifying that it wasn’t your fault that you came down with it or whatever. And so in that sense it was a good place to have it because it was much more severe on my feet than it was on my hands.
 
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Carys found it hardest to have psoriasis on her hands because her job as a nurse meant that she was using/washing them constantly and that they were an infection risk.

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Age at interview: 23
Sex: Female
Age at diagnosis: 22
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With me, my arms and my hands were difficult because I washed my hands so frequently at work that you would-, say you had four days off in between shifts, you would get it looking really, you know, feeling better and looking less angry and then you go back and you’d undo it within a few hours because you’ve washed your hands that many times, that there’s absolutely no way that you could keep them looking as good. 

Because I’d plaques on my hands and my wrists and things and that some of them broke open and at the time I didn’t, didn’t realise, but when I saw Occupational Health after all my treatment, they said that I shouldn’t have been working at that point. But, as soon as the plaques broke open on any of my skin that was like bare below the elbows that’s the NHS rules, they said I should have been off sick because I was an infection risk to myself and somebody else at that point. But I didn’t realise and to be honest didn’t think anything of it, because, because my, I didn’t have an infection. I didn’t think about it, about- which obviously didn’t sit well, cos I wouldn’t wanna put anybody at risk but I didn’t actually get any infections or anything. But I know for next time that if I was to get it again and they were to break open I’d have to be off if it was on my hands or on my arms broken. Cos my hand washing just made it worse like you know, you can’t help it. You have to wash your hands every five minutes. So the ones on my hands just never-, were probably open a lot of the time really when I think back. 
 
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The itchiness of psoriasis on her feet distracts Zara at school.

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Age at interview: 16
Sex: Female
Age at diagnosis: 2
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Once an itch starts it’s difficult to get rid of. And the more you itch it like your feet get redder and then your feet start to bleed. And it’s constantly there and it bugs you and you just, you’ve got to find some way of just forgetting about it. It’s like, it’s like having I don’t know a broken arm or something and not, and not being able to write and you always know that’s there so when you go into class you can’t write down the notes and it just becomes a lot more difficult. 

I can, I don’t know, be in English or Maths or something and my feet would get itchy and I’d, I’d like I’d curl them up in my, in my shoes to try and stop the itch and try like release some of the pain and everything and when I did that I kind of zoned out and I’d miss just that part of the lesson which might have been key so I’d try and do algebra and she’d just explained it and I wasn’t listening, it was difficult. 
Psoriasis in ‘intimate areas’

A few people talked about psoriasis in ‘intimate’ body parts, including those affected by genital psoriasis on the vulva, penis or bottom. Lucy was nervous talking to a doctor about developing psoriasis on her breasts. Abbie had some psoriasis on her bottom, which she said “obviously that wasn’t the nicest”. Some stressed it’s important to tell your doctor if you do develop it and take care with using treatments (e.g. steroids) on sensitive parts.
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