When considering the impact of skin disease, many people fail to realise just how important the psychological aspects can be. Skin disease is often considered to be ‘only cosmetic’ by many medical professionals and lay-people alike, but unlike most internal illnesses, skin disease is often immediately visible to others. It is for this reason that traditional views do not account for the often profound psychological impact that it can exert on those affected. Skin disease can affect the quality of life, self-esteem and body image, as well as the way patients live their day-to-day lives. Furthermore, the way that skin disease affects a person often has no relation to traditional conceptualisations of medical severity. To truly understand the effect, we need to understand the person behind the condition. Through the course of our work we have encountered individuals whose skin disease covers the majority of the surface of their skin but whose social and psychological functioning were unaffected by the condition. Conversely, individuals with the smallest of lesions in non-visible areas have been so affected by their condition that occupational, social and sexual interactions have fallen prey to their functional inability to cope with their condition. The unique nature of skin disease has the potential to make it both the easiest or most difficult disease to suffer and how a person copes and adapts to the challenges presented is due to a great number of factors.