Naveen Rawal, a 15-year-old struggling with acne, says in a choked voice, “Having acne made me feel like everyone is staring at my face. I try to cover it up with makeup, but kids at school still make fun of me. It made me not want to go out or be seen by anyone.”
Similarly, 12-year-old Jagat, who battles eczema, shares, “My skin always looks red from itching. People think I have something contagious and avoid sitting next to me in the class. Sometimes, I feel really lonely because no one wants to be my friend.”
Nine-year-old Rema, coping with alopecia, questions why she looks different from her peers, saying, “I don’t have any hair on my head. Kids at school call me names like ‘baldy’ and laugh at me. It makes me not want to take off my hat or go to school.”
These testimonies reflect the emotional and social challenges besides bullying and stigmatisation children with chronic skin diseases such as acne, alopecia, eczema, psoriasis, and vitiligo often face affecting their self-esteem and social interactions. This has been pointed out by a study published in JAMA Dermatology. In general, girls reported more stigma than boys. The study said over 73 per cent of participants reported experiencing stigma related to their condition. This stigma was strongly linked to lower quality of life, increased anxiety, and depression among affected children.
The study covered 1671 children, 58 per cent of them girls, with mean age being about 14 years. About 56 per cent of the children self-reported high disease visibility, while 50.5% reported moderate disease severity.
“The general burden of skin disease is sometimes difficult for people to appreciate, and even as dermatologists, we don’t always know how to ask questions about quality of life or how our perception correlates with the lived experience of patients and their caregivers,” said study author Michele Ramien, MD, Clinical Associate Professor of Pediatric Dermatology at the University of Calgary, Pediatric Dermatologist at Alberta Children’s Hospital in Calgary, Alberta, Canada, and President of the Canadian Dermatology Association.
“This study clearly shows, with validated instruments and tools, that there is a big burden and stigma associated with skin disease, and the experience of stigma is real,” she said. “It’s something we need to work on asking about more and addressing with patients.”
The study was conducted at 32 pediatric dermatology centers in Canada and the United States between 2018 and 2021, using the Patient-Reported Outcomes Measurement Instrumentation System Stigma-Skin to examine the links between disease visibility and severity and mental health and quality of life.
Nearly three quarters of children with skin disorders reported some amount of stigma. Stigma scores correlated strongly with reduced quality of life, depression, anxiety, and poor peer relationships.
In addition, about 29% of parents said they were aware of their child being bullied, primarily at school, which was strongly associated with stigma.
In general, girls reported more stigma than boys, and children with hyperhidrosis and hidradenitis suppurativa were more likely to have higher depression and anxiety scores.
“Some conditions didn’t have as much perceived stigma as we had thought, such as atopic dermatitis, while others had more than we thought, such as excessive sweating,” Ramien said.
“That speaks to the disconnect in physician perceptions and serves as a reminder to ask children and families about their experience - and to find the best way to do that without making it burdensome or stigmatizing.”
When physicians ask about mental health challenges and quality of life, they may be better able to refer children and families to the care they need. For instance, specialized dermatology treatment may help decrease the severity and visibility of the skin condition, and mental health resources may help reduce stigma, false beliefs, and internalized perceptions.
