Reality star Kim Kardashian publicly revealed a nasty rash to her dermatologist on a recent episode of "Keeping Up With the Kardashians" -- eventually leading to the delivery of an important message to the millions of Americans who have the autoimmune disease psoriasis: Be comfortable in your own skin.
The National Psoriasis Foundation is so pleased with the television diva's openness about of her skin condition that it has heralded it on its website and says it hopes it brings more awareness to a disease that can be devastating socially.
It's not just a skin condition. In about 30 percent of all cases, the disease can develop into psoriatic arthritis, a painful inflammation of the joints that can be disabling. The disease can also put patients at risk for many more serious health conditions, including heart disease, diabetes, high blood pressure, obesity and depression.
"Kim Kardashian is brave to come out when her stock and trade is being so beautiful, and I think she's got a lot of self-confidence to do that," said Catie Coman, director of communications for the National Psoriasis Foundation.
"A lot of people with psoriasis cover up and feel a certain amount of shame and embarrassment, because the disease is so visible and people think it's contagious," she said. "They face discrimination in public. Everyone with moderate to severe psoriasis has a story about being kicked out of a pool or a salon."
Psoriasis is not contagious. Both genetics and the immune system plan a role in the onset of the disease. It occurs when the immune system sends out faulty signals that speed up the growth cycle of skin cells.
The red patches most often appear on the scalp, knees, elbows and torso, but can develop anywhere. Kardashian told her doctor she was most concerned about her face, but was reassured that patches on the face are rare.
"I'd heard of psoriasis before because my mom has always had it, but she didn't have red flaky dots all over her," said Kardashian.
Her mother, Kris Jenner was also diagnosed at age 30.
Kardashian recently stepped out in a short skirt, showing off her bare legs and exposing spots of psoriasis as she shot her reality show in Los Angeles.
Psoriasis is the most common autoimmune disease in the United States, affecting as many as 7.5 million Americans. It is often misdiagnosed as a rash, ringworm or other skin irritation, such as eczema, according to the National Psoriasis Foundation.
There are five types: plaque, guttate, inverse, pustular and erythrodermic. Like Kardashian, nearly 80 percent of people with the disease have plaque psoriasis, which appears as red, raised patches.
About 30 percent of those who develop the skin disease also go on to develop psoriatic arthritis, an inflammatory form of arthritis that can be disabling.
Such was the case with Noelia Ferrerya, a 25-year-old political science student from San Diego who was diagnosed with psoriasis when she was 13. At first, the red patches were only on her scalp.
"Years passed and I got progressively worse, but didn't realize it until I was senior in high school," she said. "It was flaring on my torso and other places like my forehead and I did the same thing as Kim Kardashian, I Googled it and freaked."
Ferrerya had complained to doctors about aching joints, and fingers and toes that were red and had swollen like sausages. Doctors diagnosed psoriatic arthritis.
"It was so painful getting up in the morning, and I felt so stiff," she said.
Psoriasis: Painful and Also Embarrassing
Her worst moment came when she had an argument with a former boyfriend and he complained about her flaking skin "all over my bed and floor."
"Do you think I can control this?" asked Ferrerya. "People have told me that they couldn't get their nails done or get a haircut because people thought they were contagious. They don't know what it is and you are too scared to tell them because you think you will be rejected. There's a lot of ignorance out there."
Psoriatic arthritis can develop a decade after the skin condition is first diagnosed, according to Arthur Kavanaugh, a rheumatologist and professor of medicine at the University of California, San Diego.
Only about 25 percent have spine involvement, and it can affect the joints of the hand, the feet and often the Achilles tendon or other tendons or ligaments. It tends to run in families and is associated with a group of genes, now called the "psor genes," he said.
"It's among the stronger genetic diseases in rheumatology," said Kavanaugh. "The immune system forgets and attacks itself."
As in Ferrerya's case, it can also produce "sausage" fingers or toes -- swelling beyond the joint. One of the better known patients with psoriatic arthritis is golf player Phil Mickelson.
"Nobody wants anyone to be sick, but health is political and it certainly helps to have famous people either champion of have the disease," said Kavanaugh.
Although the disease is not curable, there are many treatments to keep the disease at bay, such as topical steroidal creams and systemic medicines called "biologics" that work on the immune system.
Because of the psoriatic arthritis, Ferrerya takes anti-inflammatory medication, but she has also found that changing her diet -- eliminating certain fruits and vegetables -- has helped. As with all psoriasis patients, she also finds relief by exposing her skin to the sun.
Ferrerya has also become active in the National Psoriasis Foundation, whose mission is rooted in support.
When founder Beverly Foster, who suffered from severe psoriasis, turned 30, her husband gave her a unique gift. He put a small classified ad in a Portland, Ore., newspaper in 1966, asking those with the disease to call his wife so she night have someone to talk to.
Foster received more than 100 calls and began organizing meetings and in 1968. That's how the foundation aimed at raising money for research was born.
But despite the national attention that Kim Kardashian brought to the disease, psoriasis still evokes derision, according to foundation spokeswoman Coman.
Though much of the reaction to Kardashian's revelations was positive, some television commentators sarcastically wondered why the big deal, when "all she has is dandruff of the leg."
"We've been monitoring the blogs and postings and people's responses have been horrid," she said. "Even some [television hosts] were saying [Wednesday] she must have an STD [sexually transmitted disease]. But psoriasis is an autoimmune disease and you wouldn't say that about someone with type 1 diabetes. That sets off a whole cycle of wanting to cover it up."
Still, Ferrerya is thrilled that Kardashian spoke up.
"People view psoriasis as such an ugly disease," she said. "And now a nice pretty girl who has all the money to buy expensive treatments, for her to come out on her show and have her moment -- the one all of us had when we were diagnosed -- it's fabulous."