Table 4.

Theme 2: conflict with the management of other illness tasks

Subthemes	Data extracts
2.1 Treatment concerns	‘ … I worry about the damage to my liver with methotrexate and also for my skin with the creams as well, because I know the steroids can damage your skin long term.’ [P13: using topical and oral therapy]
	‘I don't like the injections, it's kind of really painful and I get really nervous about it.’ [P3: using a biologic]
	‘ … It worries me the fact that I've been treating psoriasis for over 40 years now and so I'm worried about the effect of those treatments I have had over those years.’ [P16: using topical therapy]
	‘I do kind of look at my skin but I can't tell [if it's thinning or not]. How would you tell? Nobody ever notices, when I go to give blood, no one ever comments on it or anything like that.’ [P2: using topical therapy]
	‘Sometimes I worry because I don't want to become too dependent on medication, because this medication could be taken away from me at any time. It really depends on the way the NHS funding goes.’ [P3: using a biologic]
2.2 Uncertain treatment efficacy	‘ … Sometimes I feel that the treatments aren't stopping the psoriasis from increasing and sometimes I feel that the psoriasis is quite resistant and will increase, despite using the treatment … I'm not sure overall, whether they are stopping it from getting worse.’ [P4: using topical therapy]
	‘ … If this treatment that I am having now stops working … I don't even want to think about it really … because I know that at my age and given the other health problems that I have got … it's eliminated other tablet forms of treatments that um … I've had to stop because of the side‐effects.’ [P1: using topical therapy]
	‘What makes me feel uncertain about it is, you know, what other side‐effects it could pose … could it make my psoriasis worse if I ever stop taking it … I do worry whether if I ever stopped the medication, could something trigger it off to come back much, much worse than it was before. So that's a worry.’ [P3: using a biologic]
	‘I find it somewhat distressing and I have to make the decision, not knowing really what the outcome is. Not knowing if I stop using a particular cream whether I'm going to get more symptoms or if I get less.’ [P4: using topical therapy]
2.3 Stress as a casual factor of psoriasis	‘I was under a lot of stress so I did get lots of flare‐ups.’ [P10: using oral therapy]
	‘ … Being fairly active, not being able to do want I want to do, is very, very annoying and it's highly stressful and it's a vicious circle. So that brings on psoriasis even worse.’ [P5: prescribed topical therapy but using tanning beds]
	‘ … It depends on how stressed I get at work … I can be using my creams and doing my daily routine and it will still manage to creep back up to a level where I don't find acceptable.’ [P15: using topical therapy and photochemotherapy]
	‘ … I can either miss my UVB, and I know it's not great and I know I'm prescribed a course of it, or I can tell the people who I work for that I can't do this trip because I've got my psoriasis treatment … the latter would cause me so much more stress than the former and make my psoriasis worse, so you have to make decisions about things.’ [P6: using topical therapy, previously used phototherapy]
	I've only been on it 5 months, and I haven't really noticed a major difference but then I have had quite a lot of stress … I think the stress has counteracted the effectiveness of the drug.’ [P3: using a biologic]
2.4 Adjustment to psoriasis	‘ … It's more upsetting when it comes back. Because you think, this is it, I've found a cure but there isn't a cure.’ [P14: using oral therapy]
	‘I feel really self‐conscious because I've got this sort of gunk all over my head … if I put it on in the morning, I can't go out until the evening … ’ [P11: using topical therapy]
	‘ … It's the most awful thing in the world; it smells like you are creosoting a fence. So I don't want to put my partner through that.’ [P11: using topical therapy]
	‘I used to put greasy stuff in and you would be all sticky and then you would have to wash it all out and that took ages to wash out. I'm almost having nightmares just thinking about it.’ [P7: using topical and oral therapy]