The impact of psoriasis is often more than just skin deep
As Cara Delevingne pointed out, Fashion Week was the worst possible time for her skin to flare up with angry, red, dry patches.
Parading down the catwalks earlier this year, the 21-year-old model was struck by a bout of psoriasis, which she later wrote about on Twitter when she revealed that she'd even thought about changing careers because of it.
"I want to make music, I want to act and I want to sing. I want to do something that doesn't make my skin erupt," she said.
Stress isn't the only trigger for psoriasis flare-ups, but it is a big contributing factor for many people with the condition – as is the case for many autoimmune or immune-linked diseases.
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It causes raised, dry, flaky patches and can affect any area of the skin, though it varies in severity. Sometimes large areas all over the body might be covered, while others might have one or a few patches on just their hands or scalp.
There's no cure, though certain treatments and lifestyle changes can sometimes help, and it's not contagious.
Exactly why some people develop it isn't certain, but genetic factors may come into play.
"One in three people with psoriasis will have a close family member who's also affected," explains Dr Nemesha Desai, consultant dermatologist at London Bridge Hospital.
Everybody produces new skin cells, but with psoriasis this process becomes extremely fast.
"Skin cells mature in five days, instead of 28, resulting in a build-up on the surface," adds Dr Desai. "Most people experience only small areas of irritation, however it can cause scaling of large areas and even require hospitalisation in its most severe cases."
Soreness, itching and general discomfort often go hand in hand with psoriasis, but – as is the case for many chronic skin conditions – it's the psychological and emotional impact which can prove most difficult, as Jessica Gough, 20, can vouch.
In 2011, frustrated and distressed, she started writing a blog about living with psoriasis – and the results have been staggering.
"I've had psoriasis since I was seven years old, but it didn't really bother me as a child," she explains. "But at around 15, I just couldn't deal with it.
"My dad and granddad both had a small patch, but mine grew very strong, all over my body. I was more than 50% covered at one point – it was really extreme and difficult to deal with."
Jessica struggled with feeling embarrassed and ashamed of her skin, and her confidence was low.
"Having it on my hands was key," she adds. "You can cover the rest of your body, but handing over money at a till or shaking someone's hand were big things for me."
Negative experiences with doctors inspired her blog. "I was at university at the time and my skin was out of control; cracked, bleeding and sore, I was in desperate need of something to calm it down.
"The campus GP told me to come back in two weeks when they'd had a chance to read my notes and might know what to do."
Already frustrated with the level of support she'd received, this was the "cherry on the cake" for Jessica, who lives in Shropshire. Back home, she poured her thoughts onto paper and wrote about how she was feeling.
"I sent it to my parents, brother and best friend. They suggested I post it online and see what happens."
Her post struck a chord and, realising she had a keen audience, she started her blog, called 'Jessica and Psoriasis'.
Two years on, it is read by hundreds of people across the globe and has changed her life.
"I can't put into words how much it's helped me," she says. "I grew up thinking I was the only one in my situation, the only one who felt psoriasis impacted me more personally than just my skin.
"When I started writing, I had emails from people telling me they felt the same and how amazing it was that someone was writing about it."
As well as connecting with strangers with similar experiences, opening up about her condition also enabled friends and family to realise just how deeply psoriasis had affected her. As a result, it's now something she can talk about more freely and a lot of the anxiety she'd been carrying has been lifted.
"It's changed how I look at my psoriasis. For me, it's now more of a positive than a negative and I've become quite involved with psoriasis on a wider level."
Another big turning point for Jessica was having counselling. "I changed dermatologists during my teens and the new one recognised instantly how much I was suffering and how it was affecting me. Since then, things have been brilliant."
As well as finding more suitable treatments, which are working well, talking to a counsellor helped her come to terms with her feelings and put them into perspective.
"I'd advise anybody to be truthful with their doctor," she says. "Tell them how you feel. Counselling isn't a cure but it has really helped me. And there are lots of good blogs out there. The Psoriasis Association has a great website, with sections on how to cope with things such as going away to university."
Carla Renton, of the Psoriasis Association, knows that the psychological impact of the condition is one of the most crucial aspects.
"As a highly visible condition, it can have a profound impact on people's psychological and emotional wellbeing. People with psoriasis often have very low self-esteem, which may be compounded by the real or perceived reactions of others," she says.
"We often hear of people coping with it by avoiding T-shirts or shorts, not going to the hairdressers, even not having relationships. Everyone's different and there are people who cope very well with their psoriasis, but we also know that a third of sufferers experience depression and anxiety, and up to one in 10 contemplate suicide."
Carla notes that callers to the charity's helpline often talk about feeling isolated and frustrated. "It can have a huge impact on the day-to-day," she adds, as applying creams can take several hours.
Echoing Jessica's advice, she's keen to point out that support is out there. "Remember you're not alone – 1.8 million people in the UK have psoriasis. If someone is struggling to cope, it's important they open up to their doctor."
Psoriasis Awareness Week is November 1-7. For more information, visit www.psoriasis-association.org.uk or call the charity's helpline on 08456 760 076