Children With Chronic Skin Disorders Face Substantial Stigma

TOPLINE:

Most children and adolescents with chronic skin disorders may experience stigma, which is strongly associated with reduced quality of life (QOL) and childhood depression.

METHODOLOGY:

• Stigmatization has been addressed for several chronic medical conditions, such as HIV/AIDS, obesity, and mental illness; however, it has received limited attention in children living with chronic skin disorders.
• This cross-sectional, single-visit study examined the prevalence of stigma, its dependence on disease visibility and severity, and its association with mental health and QoL in children with chronic skin disorders.
• A total of 1671 children aged 8-17 years (57.9% girls; mean age, 13.7 years) were recruited from 32 pediatric dermatology centers in the United States and Canada from November 2018 to November 2021. The most common conditions were acne, atopic dermatitis/eczematous disorders, alopecia, and psoriasis, but rare genetic disorders were also represented.
• The primary outcome was the extent of stigmatization in relation to disease visibility, assessed using the Patient-Reported Outcomes Measurement Instrumentation System Pediatric Stigma-Skin.
• Secondary outcomes were the extent of stigmatization in relation to disease severity, along with QoL, depression, anxiety, and poor peer relationships.

TAKEAWAY:

• Approximately half (56.4%) of the children self-reported their skin condition as highly visible; 50.5% reported their disease severity as moderate, while 21.3% reported it as severe.
• Stigma was experienced by 73% of children and adolescents with chronic skin disease, with 43.8% reporting moderate stigma.
• Stigma scores correlated strongly with impaired QOL (Spearman ρ = 0.73) and child-reported scores for depression (ρ = 0.61) and moderately with anxiety (ρ = 0.54) and peer relationships (ρ = −0.49; all P < .001).
• Although stigma is increased for children with higher disease visibility and severity, the relatively weak correlation between child-assessed disease visibility and stigma (ρ = 0.22) showed that stigma is common in children even when diseases are not highly visible.

IN PRACTICE:

"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," the authors concluded.

SOURCE:

Amy S. Paller, MD, professor of pediatrics and dermatology, Northwestern University, Chicago, led the study, which was published online on April 24, 2024, in JAMA Dermatology.

LIMITATIONS:

Stigmatization needs to be assessed in children from low- and middle-income countries. Investigators enrolled children who had physician-assessed moderate to severe disease severity and/or at least some visibility of skin disease while wearing clothing, which resulted in exclusion of children with mild chronic disease, and the pandemic limited enrollment.

DISCLOSURES:

This study was funded through a grant from the Pediatric Dermatology Research Alliance (PeDRA). The authors declared receiving grants, personal fees, and honorarium and having other ties with various sources.