Stigmatization of chronic pediatric skin disorders impact quality of life

Stigmatization of chronic pediatric skin disorders impact mental health | Image Credit: © SNAB - © SNAB - stock.adobe.com.

Findings from a study published in JAMA Dermatology suggest that health care professionals should consider stigmatization and bullying when assessing the social and mental health of children and adolescents with chronic skin conditions. In a study that featured over 1600 children and adolescents with chronic skin conditions, stigma was an important factor in quality of life (QOL), with differing stigma scores based on skin condition severity.

To determine the extent of stigmatization associated with disease visibility, severity, mental health, and QOL in children and adolescents, the investigators developed a cross-sectional, single-visit study at 32 pediatric dermatology centers in the United States and Canada. Participants were aged 8 to 17 years with chronic skin disease that were present for at least 6 months. Eligible participants had to have a condition of "at least moderate severity and/or [a conditional that is] still visible when wearing clothes per physician assessment," according to the study investigators.

The primary endpoint of the study was to measure childhood stigma related to disease visibility, while key secondary endpoints consisted of the comparison of child-assessed stigma scores and disease severity, QOL, extent of anxiety, depression, and poor peer relationships, and parental responses.

For disease severity (mild, moderate, or severe) and disease visibility (mild [not visible when clothed], moderate [barely exposed when clothed], and severe [very visible]), physician, patient, and parent global assessments were performed.

The investigators chose Skindex-Teen and its subscales to measure QOL. Subscales measured the following physical symptoms:

• Skin pain
• Burning or stinging
• Itching
• Effect on sleep
• Skin bleeding

Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) tools for short forms of anxiety, depressive symptoms, and peer relationships were available, with the United States pediatric general population serving as the reference population. A T score of 50 is the mean for the general population. Scores greater than or equal to 60 for depression and anxiety, or less than or equal to 40 for peer relationships are 1 SD from the mean and at least moderate, wrote the study authors. T scores for mild stigma were assigned as 40 to less than 45, moderate scores were 45 to less than 55, and greater than or equal to 55 were high.

In all, the study featured 1671 children (57.9% female) with a mean age of 13.7 (2.7) years. A total of 56.4% of participants self-reported high disease visibility while 50.5% self-reported moderate disease severity.

For children with chronic skin disorders that consisted of predominately acne, atopic dermatitis, alopecia areata, and vitiligo, 27% had scores less than 40, meaning minimal or no stigma. More (43.8%) children had at least moderate stigma, with a score of 45 or greater.

Stigma scores correlated with reduced QOL (P = 0.73), depression (P = 0.61), anxiety, (P = 0.54), and poor peer relationships (P = –0.49). Among parents, 29% were aware of their child being bullied, which was strongly associated with stigma (Cohen d = 0.26). Further, children with hyperhidrosis and hidradenitis suppurativa, were most likely to have increased anxiety and depression, the authors noted.

"The findings of this cross-sectional study suggest that stigma is central to the impact of chronic skin disease on QOL and mental health," the study authors concluded. "Better treatment approaches for chronic skin diseases in children remain an unmet need. Increased awareness and instituting medical and psychological interventions to identify and reduce stigma and disease severity are important directions for improving QOL."

Reference:

Paller AS, Rangel SM, Chamlin SL, et al. Stigmatization and Mental Health Impact of Chronic Pediatric Skin Disorders. JAMA Dermatol. 2024;160(6):621–630. doi:10.1001/jamadermatol.2024.0594