I’ve had psoriasis since I was five years old. It started as a little patch on my left ankle—I remember thinking, What’s this flaky thing?—and it stayed that way for years. My dad has psoriasis and recognized it right away. So as soon as I started having symptoms, my parents took me to a pediatric dermatologist, who diagnosed me with the condition. I was told not to touch or pick at it and was prescribed a low-dosage steroid cream. That was the only course of treatment for the first half of my life.
When I was younger I was more concerned about the hair on my legs than the flaky patch on my ankle. But it started getting worse in middle school, when I was about 12 or 13. That’s when I began to realize, Oh, I have this thing. Maybe it was changing hormones or stress, but the spots started to spread. I’d get a one or two on my torso or arms, sometimes my scalp, but it still wasn’t terrible. I was using some steroid creams, and I felt lucky that the condition didn’t impact my face.
It wasn’t until my mid-20s, when I was in grad school training to be a therapist, that it started getting significantly worse. I’m 30 now, and what started as a small spot on my left ankle has become something that sometimes covers 70% of my body. (Although ironically, it has never returned to the original location on my leg!)
The mental load
I’d be a liar if I said having psoriasis hasn’t impacted my confidence. Guttate psoriasis, the type I have, presents as small, scaly red or pink clusters of spots. Right now it’s all on my buttocks, up my back, on my stomach, and under my breasts. When it first got really bad, during the pandemic, I was freaking out a little. The world felt like it was ending because of COVID, and everything was hitting at once: I was working, going to school full-time, doing an internship, and trying to navigate dating. Around the same time, the strongest steroid cream I could use before having to consider other treatments, like biologics, stopped working. I was like, What am I going to do? I just wanted to hide my body.
Mentally it was really hard. I tried to find support in Facebook groups and on Reddit, but I felt like they put me in an even more negative headspace. People share lots of polarizing opinions about treatments, and it was too easy for me to latch on to some horror story or fall into a rabbit hole of comparison. I know these spaces are intended to create community, but spending time online left me feeling more pessimistic about treatment and more depressed, so I decided it wasn’t for me.
Physically I went a little off the deep end trying treatments, from topical steroids to an oral medication to an anti-inflammatory diet to medically monitored UVB light therapy. I didn’t like the side effects of the medication and didn’t even finish the blister pack. As for the diet, I stuck with it for a month but didn’t see any impact, and it was so restrictive, I was miserable. While the UVB light therapy worked, it was time-consuming and super expensive: The sessions are $75 a pop, with the expectation that you do them every two days. In one month I spent $1,200! It gave me a nice tan and cleared up a lot of the spots, but the moment I stopped, they came back with a vengeance. I’m privileged to have been able to pay for it at all, but I just couldn’t keep up with it, financially or time-wise. The fact is, there’s no magic cure, and I felt very defeated. It was like being back at square one.
Lauren Cassot
The path to acceptance
Today I have good days and bad days. On the bad days you don’t want to be inside my head. A few years ago I was on vacation at a resort in Turks and Caicos, and a lovely woman working in the gift shop saw my legs and said, “Oh my goodness, I have something for you!” She thought my spots were bug bites. It was the first time a stranger had pointed out my psoriasis, and I cried in my hotel room afterward because I realized I don’t have control over the way people perceive and receive me. People had stared and gawked at me before, but she made it real by pointing it out.
Still, the majority of the time, I try not to let my psoriasis negatively impact me. This is where my career has really helped. I’m now a licensed mental health therapist with a private practice, working with high-achieving women navigating stress, burnout, self-esteem issues, and dating. I also previously served as a therapist at an eating disorder center. In that role, especially, I needed to model what a healthy relationship with your body looks like. I remind my clients that we don’t have to “look good” to be worthy of having a good time. I tell them, “Wear the clothes that you feel good in, and know that your body belongs, always.” I try to give myself that same permission. I consciously focus my internal dialogue on what my body does for me, not how good it looks. We are all fighting our own battles, and mine happens to be written on my skin.
Though I won’t force myself to love my skin on a bad-flare day, I can show gratitude and appreciation for how it literally protects me from the outside world. And I remind myself that my body is worthy and its purpose isn’t to look “good.” Yes, aesthetically, psoriasis is horrible, especially in the summertime, when there’s less clothing covering my body, but it doesn’t leave me feeling sick. My psoriasis is something I deal with, making up just a small fraction of who I am. I come back to this idea when I’m feeling down or self-conscious. I rarely stand in front of the mirror and pick myself apart anymore. I see a therapist and keep a gratitude journal, both of which help when my internal dialogue about my skin gets brutal—I can be my own worst bully. I also spend time in the sun (safely, of course) and make sure to moisturize. I’m not afraid to wear a bikini—but I’ll also put on my coziest sweater, loose linen pants, or my favorite PJs on days when I’m feeling less confident.
Other things I tried during my most recent flare-up were cryotherapy and cold plunging to help quiet my mind. I’ve noticed that extreme temperatures help me get out of my head, even if only temporarily.
Getting to this place of acceptance hasn’t been easy. My dad is my greatest support system, filled with empathy and riddled with guilt over “giving” me psoriasis. He’s always encouraged me not to let it define me, and says, “You’ve got to live your life. This is a lifelong thing, and you should focus on all the other amazing things you’re accomplishing.”
I’ve also been inspired by Kim Kardashian. She’s been open about having psoriasis and psoriatic arthritis, and my feeling is, if someone who has access to the very best treatments, products, chefs, and lifestyle options still struggles with these annoying red patches, what makes me any different? It’s the ultimate lean into radical acceptance: Psoriasis is something I have; it’s not who I am. It doesn’t change my worthiness when it comes to dating, happiness, success, or simply living and doing what I like to do.
Looking to the future
As of today I’ve miraculously cleared a large part of my flare that has followed me for the past five years. I returned to an old-faithful steroid ointment, clobetasol, and also use a nonsteroidal cream as maintenance.
Now that my skin is clearer, a new anxiety has arisen: What if it comes back again? But here again my training—especially my knowledge of cognitive behavioral therapy (CBT)—helps me cope. I acknowledge my harsh, critical self-dialogue, then challenge those thoughts and try to find healthier ones. With psoriasis it can feel like two steps forward and five red, flaky steps back. But I always return to self-love, separating my worth from my appearance, and trusting that one day there will be a cure. That’s what grounds me every day.
