Dermatologic concerns account for approximately 1 in 5 visits to the family doctor.1 The skin is in direct contact with the outside world, so in some sense, this is no surprise. More than 1 in 4 Americans have one or more skin conditions.2 Skin conditions also have high economic costs. A 2017 report estimates the cost of skin diseases at 75 billion dollars to Americans.3 In a study tracking the disease burden of common skin conditions in Canada from 1990 to 2017, the cost of skin diseases by various measurements such as years of life lost, years of disability, and DALY (disability-adjusted-life-years) has been steadily increasing.4
Skin conditions disrupt everyday life, especially during flare-ups, where the symptoms can worsen very quickly. Itching, burning, and irritation can be frustrating, stress-inducing, and interfere with sleep. Perhaps more challenging than the physical symptoms are the struggles with the social and psychological burden of disease. These burdens may not be visible but are often just as damaging to the patient. Visual skin conditions can cause embarrassment and distress, leading to avoidance of social activities, increased sensitivity to criticism, and negative thought patterns, leading to diminished self-confidence and depression. We live in the digital age, where there is increased preoccupation with external beauty, social media, and scrutiny of even minute “imperfections.” The interplay between the visible and invisible effects of skin conditions is complex and needs further scrutiny.
The Impact of Skin Conditions
Visible skin conditions such as eczema, psoriasis, rosacea, and acne have a substantial impact on patients. The first problem is that many skin conditions are chronic. While some skin concerns like bacterial infections have a simple cure and a short recovery time, most, such as eczema, psoriasis, rosacea, and acne, do not. Treatments will often manage the symptoms temporarily, but there are still limitations:
- Treatments will often take time (days to months) to reach its full effect.
- Symptoms will frequently return.
- Flare-ups (a sudden worsening of symptoms) can be unpredictable.
Secondly, the social and psychological impact of the disease is both significant and long-lasting. Everyone can empathize with a child being bullied for his or her appearance. The psychosocial effects on adults may not be so apparent to those without visible skin conditions. Dealing with physical symptoms is only half the battle.
- Self-consciousness about their skin
- Discourages social functioning
- Negative thought patterns
The psychological and social effects that skin conditions can have are often long-lasting. Our culture values appearance, but it simultaneously shames and criticizes preoccupation with appearance. Those with skin conditions often feel self-critical. In addition to common psychological problems like anxiety, depression, suicidal ideation, and decreased self-esteem, patients often adapt poorly by anticipating rejection, becoming more sensitive to attitudes of society, and feel more guilt and shame.5 Surprisingly, the severity of the skin condition is only weakly correlated to the disease’s psychological burden.6 Patients or parents of children with skin conditions need to consider mental wellness as a separate issue even when the symptoms are mild. Most skin conditions will wax and wane, but its impact on self-esteem, confidence, and sense of self-worth can be long-lasting as body-image is a vital part of a person’s self-esteem.
Living with a chronic skin condition and managing wellness is a challenge. While each individual is unique, there are some key points that everyone who suffers from chronic skin conditions can benefit from.
- Realistic expectations
- Lifestyle management
Chronic skin conditions tend to wax and wane. They are sometimes unpredictable. An essential component of living with skin conditions is about managing expectations. The unfortunate truth is that many chronic skin conditions have no cure today. It can be depressing news, but having realistic expectations is critical. False expectations lead to lower treatment compliance and worse outcomes. When patients are realistic about their expectations, they manage their symptoms more effectively and are psychologically better prepared for setbacks.
Educate yourself about the skin condition. Understand the big picture about whom it affects, how to control it, and how it affects you specifically. Educating yourself provides perspective. It helps you understand that you aren’t suffering alone.
Lifestyle adjustments are unique to the individual. Skin conditions vary in severity, in how it affects the individual. People also have different treatment priorities, as well as expectations. Have realistic expectations, educate yourself about your condition, and follow through with appropriate treatment and lifestyle adjustments that work for you.
If you have a skin condition or have family and friends who do, learn more to help yourself and others. Understanding that skin conditions are more than skin deep can really help a friend, child, or sibling in need of support.
The Canadian Skin Patient Alliance (CSPA) is an advocate for Canadians with all kinds of skin conditions, and traumas. They help educate people about skin conditions and advocate for patients with skin conditions. The CSPA also has numerous alliances with organizations that have a narrow focus on specific skin conditions.
For Americans, the American Academy of Dermatology has numerous resources for patients, from skincare to skin conditions. It’s a comprehensive resource for information about general skin advice, lifestyle, as well as medical information.
For specific skin conditions:
1Julian CG. Dermatology in general practice. Br J Dermatol 1999;141:518-20