The Impact of Skin Disorders on Quality of Life

The Impact of Skin Disorders on Quality of Life

1. Introduction

Quality of life can be defined as the general well-being of the emotional, physical, and social aspects of life. A man named Abraham Maslow proposed that there existed a hierarchy of needs in humans. This hierarchy consisted of 5 main categories which are shown as a pyramid (See appendix A). At the base of the pyramid, there exists the ‘physiological needs’ category. This is at the top of the list of priorities for someone who is suffering from a skin condition as many disorders affect the function of the skin in retaining vital body fluids, body temperature regulation, and protection against harmful biochemical agents (Maslow said that the needs at the base of the pyramid are the most pressing).

The skin is the largest organ in the human body and at 10% of the body’s surface area, is an important medium of interaction with the world. The major functions of the skin can be summarized as a protective barrier to physical, chemical, and ultraviolet damage to the body, the ability to notify the brain of an object’s physical properties (e.g. shape or size), retention of vital body fluids, a controller of body temperature, and the synthesizing of Vitamin D and carrying out of associated metabolic activities. It is clear, therefore, that any skin disorder, acute or chronic, is going to impede on one or many of these functions and in doing so will affect the overall quality of life for the sufferer.

This introduction will contain a brief overview of skin and its functions in the human body. It will also outline the functions of skin and detail some of the known psychological difficulties associated with skin disorders such as acne, vitiligo, and atopic eczema. The introduction will conclude with the rationale and aims of the essay.

2. Prevalence of Skin Disorders

The prevalence portion of the study by Koo and Lebwohl was primarily descriptive. It relied on other valid studies to present a base for their research into quality of life. Koo and Lebwohl first define prevalence as the number of people with the diagnoses of the targeted disease at a given time and state that it is useful in recognizing the public health importance of a cause. The other aspect of the study measuring incidence was somewhat ignored in this portion of the article. Koo and Lebwohl did not compare it to the incidence rate, although they do mention it in the discussion. The studies which were cited by Koo and Lebwohl used several different study designs to measure the prevalence of the studied diseases. Future research may be directed toward an incidence comparison and determining which method works best given a specific disease. This article presents a broad picture of the prevalence of skin diseases in the United States, and mention is made to the international community. Much of the research that was cited was in the past 40 years. This portion of the article gives the reader a good idea of where this research is coming from and what diseases will be comparable with the present. Koo and Lebwohl target mainly adult populations because the studies that are presented show data for 18 years of age or older. No studies could be found on the prevalence of the many skin diseases most common in children. This may be a target of future research given the impairment these diseases may have on a child’s quality of life.

3. Physical and Emotional Impact

The study of the impact of skin diseases on physical and emotional wellbeing represents a rapidly growing area of interest. Studies measuring the degree of physical and emotional impairment experienced by patients with skin disease have been conducted using generic and specific health-related quality of life measures. These range in scope and detail from simple visual analogue scales to complex multi-part questionnaires. Generic health-related quality of life instruments are designed to measure a wide variety of physical and emotional states, ranging from mobility to self-esteem and morale. These instruments are useful for comparing the relative impact of different diseases. Specific health-related quality of life measures are designed to be sensitive to the particular symptoms and concerns of patients with the disease in question. The purpose of these questionnaires is to enable investigators to gain an in-depth understanding of the problems faced by patients, thereby identifying areas which can be targeted for intervention. In order to illustrate the various ways in which skin disease can affect a patient, quality of life studies have compared healthy individuals with those suffering from skin disease in terms of questionnaire scores. Other methods of assessment employed by researchers include in-depth interviews and daily life diaries kept by patients, both of which can provide useful qualitative data.

4. Social Consequences

Teens with acne: Self-perceptions for socialization People form first impressions based on a global evaluation of an individual that is constructed from a wide range of information. Appearance plays a large role in determining how others perceive and evaluate an individual upon first meeting and is based on appearance-based stereotypes. These stereotypes are then used to infer personality, intelligence, and ability. For teens, the importance of looking one’s best is at a critical stage in development when they are forming their identities. Because of the normative increased importance of appearance during adolescence, we would expect that teens with acne would be at high risk for being negatively stereotyped based on their appearance. Recently, it has been shown that the negative stereotypes towards those with acne are strong. People tend to perceive adolescents with acne as being less aggressive but more successful than their clear-skinned counterparts. This may be because people believe that those with acne have isolated themselves to avoid negative social interactions and have thus been able to focus on school and future career goals. An Australian study found that acne is indeed correlated with a decrease in psychosocial functioning and a low preference for social activities; however, these effects were not associated with the severity of the acne, but with misperceptions about the causes of acne and the effects of having acne. This shows that people may be aware that acne sufferers feel social discomfort and may be avoiding certain social situations, but are misattributing the reason for this behavior. Severe acne sufferers were also rated by their peers as having less social skills. This may be due to the tendency for those with acne to feel self-conscious about their appearance and act as though they are uncomfortable in social situations, when in reality they are not lacking in social skills. An evaluative study found that when shown pictures of those with clear skin and those with acne, participants rated those with acne as having less desirable personality traits. These negative stereotypes and evaluations made by others, as well as feelings of being unattractive, can lead to a negative self-concept and low self-esteem. Acne sufferers may then attempt to master social situations with overcompensation in an attempt to disconfirm the stereotype that they are shy or nervous. Although overcompensation has been shown to buffer mood-related self-esteem, it is not an effective strategy for enhancing global self-esteem and can lead to disappointment and frustration.

5. Strategies for Improving Quality of Life

Use of the Skindex or similar tools to monitor therapy progress and regularly screen for significant impact or impairment in quality of life. Patient education about the nature of their skin disease, treatment expectations, and potential impact on their quality of life. Accurate diagnosis and effective treatment of skin disease is essential to improve quality of life. This may often involve referral to a dermatologist. Involvement of the patient in their own care in order to improve adherence to treatment regimens. Shared decision making between patient and provider. Considering the “person” in patient with chronic skin disease. Recognition of the visible nature of skin disease and its potential impact on self-esteem, body image, and sense of identity. Taking into account the psychological and social implications on individuals and targeting therapies and interventions to these specific areas can result in greater improvement in quality of life.

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