Skin Deep Isn’t Enough: Looking After the Whole Patient in Dermatology Care

Skin Deep Isn’t Enough: Looking After the Whole Patient in Dermatology Care

To date, there are nearly 200 biomedical publications on skin and psychosocial distress published so far in 2022 alone. And despite dermatology’s late formalization as a specialty in the 18^th century, negative social commentary and conduct about skin appearances have been recorded since 1500 BCE.

Additionally, the often-revolting naming of skin conditions seems to further emphasize the negative feelings and beliefs of society. For example, “psora” has its taxonomical origins associated with fungi; and “lepra” having Greek origins meaning “scale.”

The unfavorable physical appearance of skin condition and its lexicon combined are likely responsible for unsympathetic social stigmas and behaviors, often leading to psychosocial distress for those with skin conditions. That’s why we’re taking a look at how dermatologists can help raise awareness and offer support to those patients with skin conditions who might be suffering on the inside as well.

Raising Awareness

First, it’s important to know that psychosocial health includes one’s being (spiritual), feeling (emotional), thinking (mental), and relating (social). Self-care cannot be underrated and should include activities to develop and keep a healthy mind, body, and spirit—all of which contribute to a person’s overall quality of life (QoL).

Fortunately, tools like the Dermatology Life Quality Index (DLQI) or the Treatment of Autoimmune Bullous Disease Quality of Life (TABQOL) can help identify patients who may be experiencing psychosocial distress.

The validated DLQI is a brief, weekly administered questionnaire that evaluates the effect of skin diseases on a patient’s QoL. It consists of 10 questions focusing on things like symptoms, daily activities, leisure, work and school, personal relationships, and treatment, and it takes about two minutes to complete, so it won’t take away too much time in appointments.

Tjokrowidjaja et. al.,’s TABQOL questionnaire, on the other hand, evaluates the impact of treatment for autoimmune bullous diseases on a patient’s quality of life. While this questionnaire is a bit more time intensive as there are 17 questions for patients to answer, it’s another helpful tool for a dermatologist’s toolbox.

But even beyond these essential instruments, simple observations and questions, such as seeing a patient wearing a long-sleeved turtleneck sweater during the summer and following up with an open-ended question about one’s daily wardrobe, can serve as an entry point to offer more insight into a patient’s psychosocial well-being.

Offering Support

When it comes to supporting patients, it goes without saying that the ideal scenario would be for interdisciplinary specialists to coordinate care. But unfortunately, reality often dictates less favorable situations. All is not lost, however, as there are still ways to identify patients who are showing signs of psychosocial distress.

While an empathetic response can be immediately helpful, it’s only temporary. That’s why publications from the WHO and Anees and Cohen provide the following strategies to support these patients:

• Positive self-image and self-efficacy
• Realistic optimism
• Adaptability
• Developing proper coping mechanisms
• Social engagement
• Asking for and accepting support from others

With all this being said, the importance of reducing social stigma related to skin conditions cannot be underestimated. So now the question becomes: what steps will you take to better understand and promote your patients’ psychosocial well-being?

References

Anees, Muhammad Aamir, and Bernard A. Cohen. 2022. “Scrutinizing the Psychosocial Impact of Skin Diseases.” Contemporary PEDS Journal 39 (2). https://www.contemporarypediatrics.com/view/scrutinizing-the-psychosocial-impact-of-skin-diseases.

Ferreira, Iago Gonçalves, Magda Blessmann Weber, and Renan Rangel Bonamigo. 2021. “History of Dermatology: The Study of Skin Diseases over the Centuries.” Anais Brasileiros de Dermatologia 96 (3): 332–45. https://doi.org/10.1016/J.ABD.2020.09.006.

Ito, Taisuke, Kazumasa Kamei, Akira Yuasa, Fumihiro Matsumoto, Yayoi Hoshi, Masafumi Okada, and Shinichi Noto. 2022. “Health-Related Quality of Life in Patients with Alopecia Areata: Results of a Japanese Survey with Norm-Based Comparisons.” The Journal of Dermatology, March. https://doi.org/10.1111/1346-8138.16364.

Laughter, Melissa R., Mayra B.C. Maymone, Chante Karimkhani, Chandler Rundle, Sophia Hu, Sophia Wolfe, Katrina Abuabara, et al. 2020. “The Burden of Skin and Subcutaneous Diseases in the United States From 1990 to 2017.” JAMA Dermatology 156 (8): 874–81. https://doi.org/10.1001/JAMADERMATOL.2020.1573.

“Leprosy.” 2022. World Health Organization. January 11, 2022. https://www.who.int/en/news-room/fact-sheets/detail/leprosy.

Luck-Sikorski, C., P. Roßmann, J. Topp, M. Augustin, R. Sommer, and N. A. Weinberger. 2022. “Assessment of Stigma Related to Visible Skin Diseases: A Systematic Review and Evaluation of Patient-Reported Outcome Measures.” Journal of the European Academy of Dermatology and Venereology 36 (4): 499–525. https://doi.org/10.1111/JDV.17833.

Rashid, Hanan, Mila Poelhekken, Joost M. Meijer, Maria C. Bolling, and Barbara Horváth. 2022. “The Positive Impact of Rituximab on the Quality of Life and Mental Health in Patients with Pemphigus.” JAAD International 7 (June): 31–33. https://doi.org/10.1016/J.JDIN.2022.01.004.

Tjokrowidjaja, A., B. S. Daniel, J. W. Frew, D. F. Sebaratnam, A. M. Hanna, S. Chee, A. Dermawan, et al. 2013. “The Development and Validation of the Treatment of Autoimmune Bullous Disease Quality of Life Questionnaire, a Tool to Measure the Quality of Life Impacts of Treatments Used in Patients with Autoimmune Blistering Disease.” British Journal of Dermatology 169 (5): 1000–1006. https://doi.org/10.1111/BJD.12623.