Predictors of perceived stigmatization in patients with psoriasis

Prevalence and Causes of Stigmatization Among Patients With Chronic Skin Diseases in Saudi Arabia

BACKGROUND

Skin diseases can lead to stigmatization with negative consequences for patients' quality of life and mental health.

AIM

The aim of this study was to estimate the prevalence of stigmatization experienced by patients with vitiligo, psoriasis, acne, rosacea, or atopic dermatitis and to assess the relationships between the level of stigmatization and patient characteristics.

METHODS

This cross-sectional study included adult patients with vitiligo, psoriasis, acne, rosacea, or atopic dermatitis attending the dermatology clinics of various general hospitals in Saudi Arabia. Stigma levels were assessed using the six-item Stigma Scale.

RESULTS

The prevalence of stigmatization was 90.4% among the 280 patients included. Multiple regression analyses revealed the factors that independently and significantly increased the level of stigmatization. These included male gender (B = 4.300, 95%CI 3.407-5.192, P <0.001), positive family history of skin conditions (B = 2.267, 95%CI 1.139-3.395, P <0.001), number of skin diseases (B = 2.357, 95%CI 0.998-3.716, P = 0.001), and presence of facial lesions (B = 2.455, 95%CI 1.206-3.705, P<0.001).

CONCLUSIONS

The prevalence of stigmatization is high among patients with chronic skin diseases in Saudi Arabia. Identifying patients at risk for high levels of stigmatization may allow them to be provided with appropriate social and psychological support.

Investigating the prevalence of body dysmorphic disorder among Jordanian adults with dermatologic and cosmetic concerns: a case-control study

Body Dysmorphic Disorder (BDD) is an underexplored psychiatric condition in Middle Eastern countries, particularly in patients with dermatologic concerns, where alterations in appearance may elevate the risk of BDD. We studied patients at Jordan University Hospital's general dermatology and cosmetic clinics from July to September 2022, comparing them to healthy controls. Patients with dermatologic conditions were evaluated per the International Classification of Diseases (ICD-10) criteria by trained dermatologists. All participants completed the Dysmorphic Concerns Questionnaire (DCQ), Perceived Stress Scale, Patient Health Questionnaire-2, General Anxiety Disorder Assessment tool-2. We assessed BDD prevalence using four DCQ cutoffs: 9, 11, 14, and 17, reporting effect sizes as odds ratios (OR). Our study involved 1500 participants, with an average age of 29.3 (± 14.8) years and a female-to-male ratio of 3.15-to-1. At the 9, 11, 14, and 17 DCQ cutoffs, BDD prevalence was 78.2%, 54.2%, 26.5%, and 11.7%, respectively. Patients with dermatologic concerns were more likely to exhibit clinical BDD symptoms than controls at the 11-cutoff (OR: 1.26; 95% CI 1.01-1.58; p < 0.05). Conversely, those with cosmetic concerns were more prone to clinical BDD than controls at cutoffs 9 (OR: 2.26; 95% CI 1.28-3.97; p < 0.05) and 11 (OR: 1.50; 95% CI 1.03-2.20; p < 0.05). Our logistic regression revealed consistent associations between higher DCQ scores and elevated anxiety, depression, perceived skin disease-related stigma, and reduced quality of life (p < 0.05). In conclusion, patients with dermatologic issues and those seeking cosmetic procedures are at significant risk of developing BDD, necessitating proactive screening and referrals for specialized care by dermatologists due to the associated psychological distress and unproductive consultations. Providing specialized training for healthcare professionals to establish an integrated care approach to address the needs of patients with BDD should be the focus of future research projects.

Burden of Topical Treatments in Psoriasis and Preferred Criteria of Choice: A Survey-Based Evaluation of Patients in Europe

INTRODUCTION

Topical treatments (TT) are widely used in psoriasis management. While psoriasis itself has been associated with diminished quality of life and mental well-being, the impact of TT remains underexplored. This study aimed to evaluate the burden of TT on the daily lives of patients with psoriasis, the convenience of the TT, and the choice criteria.

METHODS

Patients were recruited across five countries (France, Germany, Italy, Spain, UK) by Wefight and the International Federation of Psoriasis Associations (IFPA) to complete a 29-item online survey.

RESULTS

A total of 766 patients completed the survey (54% female, mean age of 53 years). The mean body surface area covered by psoriasis was 7%, predominantly on the scalp and elbows. Participants had been living with psoriasis for a mean duration of 18 years. Of the respondents, 34% reported feeling affected by their TT in their daily routines and activities. Those feeling affected were more likely to have a more complex disease, be using more treatments, or be diagnosed more recently compared to those less affected. Among those most affected by their TT, 27% reported a strong impact on mental health, 30% on sexual life, and 25% on physical activities, compared to 7%, 6% and 4% in those least affected, respectively. Both cohorts considered tolerability factors such as "does not cause itching/burning" and "good tolerability" as most important when choosing a topical. However, only least affected participants regarded convenience factors such as "does not run off," "ease of application," "does not leave stains" among others equally as important.

CONCLUSION

Overall, one-third of patients report a significant burden of TT on their daily lives. These patients have different criteria of choice, highlighting the importance of communication between physicians and patients to tailor treatment to individual preferences, thereby enhancing adherence and treatment outcomes.

Erasing stigmas through storytelling: why interactive storytelling environments could reduce health-related stigmas

In this article we describe how designers can apply storytelling to reduce health-related stigmas. Stigma is a pervasive problem for people with illnesses, such as obesity, and it can persistently hinder coping, treatment, recovery, and prevention. Reducing health-related stigma is complex because it is multi-layered and self-perpetuating, leading to intertwined vicious circles. Interactive storytelling environments can break these vicious circles by delimiting the narrative freedom of stigma actors. We theoretically explain the potential of interactive storytelling environments to reduce stigma through the following seven functions: 1) expose participants to other perspectives, 2) provide a protective frame, 3) intervene in daily conversations, 4) persuade all stigma actors, 5) exchange alternative understandings, 6) elicit understanding and support for stigma victims, and 7) support stigma victims to cope with stigmatization. We elaborate on these functions through a demonstration of an interactive storytelling environment against weight stigma. In conclusion, this article is a call on designers for health and wellbeing, scientists, and practitioners from various disciplines to be sensitive to the pervasiveness of stigma and to collaboratively create destigmatizing storytelling environments.

Stigmatization among Patients with Plaque Psoriasis

The aim of the study was to analyze the level of stigmatization among patients with plaque psoriasis according to their demographic and clinical characteristics. The study included 122 patients who completed the 6-item and 33-item Feelings of Stigmatization Questionnaire and a sociodemographic survey. The analysis of the 6-item Stigmatization Scale showed a mean stigmatization score of 6.4 points. (Me = 6; s = 3.7); the mean score for the 33-item scale was 81.3 points (Me = 79.5; s = 19.9). Female patients felt stigmatized more often than males. Respondents living in the countryside had a stronger sense of stigmatization in the Sensitivity to Others' Attitudes (p = 0.0238) and Secretiveness (p = 0.0234) domains. The presence of psoriatic lesions across the entire body was the only explanatory variable significantly determining the level of stigmatization in the Positive Attitudes domain, either through the main effect or through the interaction with the patient sex. A highly significant difference was found for the feeling of being flawed domain (p = 0.044), with a mean score of 13.4 points. The issue of stigmatization in psoriasis deserves more attention, as the analysis of this problem may provide a better insight into the effect of the disease on the patient's condition, not merely in the context of its clinical manifestation.

[Stigmatization and social anxiety in patients with skin diseases]

Stigmatization of patients with skin diseases has only recently attracted more attention in research. However, both external stigmatization by society and self-stigmatization by the affected patients are widespread in patients with skin diseases. Many studies show that in this group of patients, the experience of both kinds of stigmatization is associated with psychosocial burden, such as social anxiety. This is often independent of the visibility of skin lesions. The psychosocial burden of affected individuals may lead to psychological comorbidities, such as depression or anxiety disorders, making it important to screen patients in dermatologic settings for the presence of these conditions. Interventions to reduce external and self-stigmatization have been developed, but more randomized controlled trials are needed to test the effects of such interventions.

The Extent of Misconceptions, Negative Prejudices, and Discriminatory Behaviors Toward Psoriasis Patients: A Cross-Sectional Survey Study Among the Population of Jeddah, Saudi Arabia

Background Psoriasis is a chronic inflammatory disease that affects around 2% of the population. The lives of psoriasis patients are greatly impacted by stigma and social exclusion, regardless of the severity of the condition. This is the first study of its kind to be conducted in Saudi Arabia. This study aimed to assess peoples' psoriasis-related misconceptions, negative prejudice, and discriminatory behaviors. Methodology A self-administered Google Forms survey was distributed between January and February 2023. The survey was conducted among residents of Jeddah, Saudi Arabia who were enrolled randomly via social media. We aimed to investigate their perception and awareness related to psoriasis, as well as how varying educational levels, age groups, and genders affected these variables. Results In total, 803 individuals participated in the survey. Results showed that 19.9% of the participants did not know about psoriasis. Only 5.1% of respondents stated that they were well knowledgeable about psoriasis. Moreover, psoriasis was more frequently perceived as a communicable disease by people in the age group of 18-29 years (p = 0.000). Surprisingly, only 43.5% of the participants reported that they would shake hands with someone with psoriasis without hesitation. Additionally, 40.7% of the participants were aware that psoriasis requires lifelong treatment. Moreover, the belief that psoriasis does not require lifelong therapy was more prevalent among university graduates (p = 0.000). Conclusions This study found that the residents of Jeddah need further education on skin disorders, in general, and psoriasis, in particular. Future studies should be conducted utilizing various approaches, with a greater emphasis on certain groups of people who engage physically with psoriasis patients.

Stigmatization, a social perception which may have a debilitating impact on hidradenitis suppurativa patients: an observational study

Hidradenitis suppurativa (HS) is a debilitating disease and patients are prone to feelings of stigmatization. In our cohort, we assessed how feelings of stigmatization may relate to patient quality of life (QOL), depression, and social anxiety. Participants completed the Dermatology Life Quality Index (DLQI) to assess QOL, Patient Health Questionnaire 9 (PHQ-9) to assess depression, the Brief Fear of Negative Evaluation (BFNE) to assess social anxiety, and an adapted version of the Feelings of Stigmatization (FoS) to assess stigmatization. The FoS also correlated with DLQI (R = 0.68), PHQ-9 (R = 0.42), and BFNE (R = 0.52). Participants with greater FoS were also more likely to have worse QOL (18.1), higher levels of depression (11.1), and higher social anxiety (30.1), as compared to those with less FoS (6.7, P < 0.001; 4.9, P < 0.001; 23.2, P < 0.001, respectively). HS is a chronic disease with no definitive treatment. Effective screening protocols, coupled with pharmacological and nonpharmacological interventions, may help patients with HS's psychosocial burden.

Type D Personality as a Marker of Poorer Quality of Life and Mood Status Disturbances in Patients with Skin Diseases: A Systematic Review

Type D personality is characterized by social inhibition and negative affectivity. Poorer outcomes and worse quality of life have been linked to type D personality in patients with a variety of non-dermatological diseases. Despite increasing evidence of the importance of type D personality in skin diseases, there are no reviews on this subject. The aim of this review is to summarize the current evidence regarding type D personality and skin diseases. A systematic search was performed using Medline and Web of Science databases from inception to 11 October 2022. Studies addressing the presence of type D personality, its associated factors, its impact on the outcomes of the disease or the quality of life of the patients were included in the systematic review. A total of 20 studies, including 3,124 participants, met the eligibility criteria and were included in the review. Acne, hidradenitis suppurativa, psoriasis, melanoma, atopic dermatitis, chronic spontaneous urticaria and pruritic disorders were the main diseases assessed. Type D personality was more frequent among patients with skin diseases than among controls. Type D personality was found to be associated with poorer quality of life and higher rates of psychological comorbidities in patients with skin diseases. In conclusion, type D personality appears to be a marker of patients with increased risk of poorer quality of life and higher rates of psychological comorbidities. Screening for type D personality in specialized dermatology units might be beneficial to identify patients who are more psychologically vulnerable to the consequences of chronic skin diseases.

Increased risk of suicidality in patients with psoriasis: A Nationwide cohort study in Korea

BACKGROUND

Psoriasis has a devastating psychological impact on patients' quality of life. However, the relationship between suicidality and psoriasis remains unclear.

OBJECTIVE

This study analysed and compared the risk of suicidality (suicidal ideation, suicide attempt and completed suicide) between patients with psoriasis and the general population.

METHODS

This nationwide, population-based, retrospective, cohort study analysed the Korean National Health Insurance Service claim data from 2005 to 2018.

RESULTS

The study included 348,439 patients with psoriasis aged over 18 years and with age- and sex-matched controls. The risk of suicidality was higher in the psoriasis group than in the control group [adjusted hazard ratio (aHR) 1.21; 95% confidence interval (CI), 1.18-1.24]. The aHR of suicidality was higher in the psoriatic arthritis group (aHR, 1.46; 95% CI, 1.39-1.54) than in the psoriasis-alone group (aHR, 1.17; 95% CI, 1.13-1.20). However, the severity of psoriasis and suicidality showed no correlation (mild psoriasis group: aHR, 1.22; 95% CI, 1.18-1.25; moderate-to-severe psoriasis group: aHR, 1.16; 95% CI, 1.10-1.23).

CONCLUSION

Patients with psoriasis have an increased risk of suicidality. In particular, the presence of arthritis in patients had a more significant effect on the risk of suicidality.

Psoriasis in Northern Saudi Arabia: Clinical features and implications for quality of life

Introduction:

Psoriasis is a chronic non-contagious inflammatory skin disorder, which might impair patient’s social relationships, limit leisure activities, and lower self-esteem. Psoriasis patients might be stigmatized leading to psychological disorders such as anxiety and depression.

Objectives:

This study aimed to outline the clinical features of psoriasis and its effects on quality of life, and the feeling of stigmatization among psoriasis patients.

Methods:

This cross-sectional questionnaire-based study was conducted on 109 adult psoriasis patients in Arar City, Saudi Arabia. The study collected data on socio-demographic and clinical characteristics of psoriasis patients, self-reported psoriasis severity using the self-assessment Simplified Psoriasis Index (sa-SPI-s), patients’ quality of life using the dermatological life quality index (DLQI), and the feeling of stigmatization using the six-items stigmatization scale.

Results:

The mean age of psoriasis onset in studied patients was 20 (±7.65) years, females represented 58.72%, and 22% were unemployed. Joint and nail affection were reported in 46.79% and 51.38%, respectively. One third of patients had positive family history of psoriasis. Seasonal variation, life stressors, smoking and skin injuries were frequent provocative factors for psoriasis lesions. The average sa-SPI-s was 10.08 (±10.41), which was correlated with patients’ ages, disease duration, obesity, and pruritis. The average DLQI and six-items stigmatization scale for psoriasis patients were 8.95 (±5.77) and 7.61 (±4.5), respectively that were correlated with sa-SPI-s.

Conclusion:

The clinical manifestations and chronicity of psoriasis impaired patients’ quality of life and accompanied with social stigma due to skin disfigurement. These effects need to be addressed for better care of patients.

The Implication of Misinformation and Stigma in Age-Related Quality of Life, Depression, and Coping Mechanisms of Adult Patients with Psoriasis

Background and Objectives: Stigma and lack of acceptance in society might have detrimental effects on the quality of life of patients with psoriasis, sometimes being comparable with other chronic diseases and conditions that affect the appearance of a patient, such as burns. Therefore, we surveyed our patients diagnosed with psoriasis to determine the implications of misinformation and stigma for their quality of life, depression, and coping strategies stratified by different age categories. Materials and Methods: A cross-sectional study was designed for a sample size of a minimum of 45 patients considering a prevalence of psoriasis of 2–3% in the general population. The study participants (patients and controls) were given both a paper-based unstandardized questionnaire and an online version of three standardized surveys. The cohort of patients was further split into three age groups to determine their age-related quality of life and coping mechanisms. Results: The proportion of patients with a history of depression and depressive symptoms among patients with psoriasis was significantly higher. Multiple discrepancies were observed between patients and controls regarding questions that targeted stigma and misinformation. On the Coping Orientation to Problems Experienced Inventory (COPE-60) questionnaire, older patients were more likely to use positive coping mechanisms such as engagement and problem-focused coping, while the young patients were using more emotion-focused coping mechanisms. However, patients in the 30–50 age range group scored the highest on physical and mental health among all participants who filled the 12-Item Short Form Survey (SF-12) survey. The Dermatology Life Quality Index (DLQI) results showed significantly more patients answering “a lot and very much” concerning embarrassment and social activities, while sexual difficulties affected the older patients. The strongest correlations with depression were observed in the young patient group, who believed that psoriasis can cause skin cancer (rho = 0.418) and who had sexual difficulties (rho = 0.414) and embarrassment (rho = 0.359) as evaluated by the DLQI survey. In the 30- to 50-year-old group, the strongest correlations were with the feeling of being stigmatized (rho = 0.376), having sexual difficulties (rho = 0.367) and disengagement coping style (rho = 273). Conclusions: While the respondents are reasonably well-informed regarding psoriasis, a degree of stigma remains, likely due to involuntary emotional responses such as repulsion and embarrassment. It is essential to establish initiatives aimed at educating the general public, raising awareness, and establishing a more tolerant social environment for psoriasis patients.

No preconscious attentional bias towards itch in healthy individuals

Rapidly attending towards potentially harmful stimuli to prevent possible damage to the body is a critical component of adaptive behavior. Research suggests that individuals display an attentional bias, i.e., preferential allocation of attention, for consciously perceived bodily sensations that signal potential threat, like itch or pain. Evidence is not yet clear whether an attentional bias also exists for stimuli that have been presented for such a short duration that they do not enter the stream of consciousness. This study investigated whether a preconscious attentional bias towards itch-related pictures exists in 127 healthy participants and whether this can be influenced by priming with mild itch-related stimuli compared to control stimuli. Mild itch was induced with von Frey monofilaments and scratching sounds, while control stimuli where of matched modalities but neutral. Attentional bias was measured with a subliminal pictorial dot-probe task. Moreover, we investigated how attentional inhibition of irrelevant information and the ability to switch between different tasks, i.e., cognitive flexibility, contribute to the emergence of an attentional bias. Attentional inhibition was measured with a Flanker paradigm and cognitive flexibility was measured with a cued-switching paradigm. Contrary to our expectations, results showed that participants attention was not biased towards the itch-related pictures, in facts, attention was significantly drawn towards the neutral pictures. In addition, no effect of the itch-related priming was observed. Finally, this effect was not influenced by participants’ attentional inhibition and cognitive flexibility. Therefore, we have no evidence for a preconscious attentional bias towards itch stimuli. The role of preconscious attentional bias in patients with chronic itch should be investigated in future studies.

The Burden on Cohabitants of Patients with Chronic Spontaneous Urticaria: A Cross-Sectional Study

Chronic Spontaneous Urticaria (CSU) has been associated with patients’ poor quality of life. Despite being a chronic disease that could alter the quality of life of the people who live with patients, the potential burden on their cohabitants has not been studied to date. The aim of this study is to analyze the relationship between the patient’s quality of life, disease control, disease duration and family quality of life and the cohabitant’s mood disturbances, sexual dysfunction, type D personality and sleep quality. A cross-sectional study including patients suffering from CSU and their cohabitants was performed. Sociodemographic variables and disease activity, quality of life, sleep, sexual disfunction, anxiety, depression and type D personality were collected using validated questionnaires. Sixty-two subjects, 31 CSU patients and 31 cohabitants, were included in the study. Worse disease control and poorer quality of life in patients were associated with poorer family quality of life and higher rates of anxiety among the cohabitants (p < 0.05). Patients’ poor quality of life was associated with reduced sexual satisfaction among the cohabitants (p < 0.05). Long disease duration (>10 years) was associated with an increased prevalence of type D personality among the cohabitants (prevalence ratio: 2.59, CI 95% 1.03−7.21). CSU seems to have an impact on the quality of life of cohabitants, especially in terms of increased rates of anxiety, poorer quality of life and reduced sexual satisfaction. The prolonged course of the disease could be associated with the increased presence of non-adaptative personality traits.

Body dysmorphia in common skin diseases: Results of an observational, cross-sectional multi-centre study among dermatological out-patients in 17 European countries

BACKGROUND

Body dysmorphic disorder (BDD) is a common psychiatric disorder associated with high costs for healthcare systems as patients may repeatedly ask for different, often not effective interventions. BDD symptoms are more prevalent in patients with dermatological conditions than the general population, but there are no large sample studies comparing the prevalence of BDD symptoms between patients with dermatological conditions and healthy skin controls.

OBJECTIVES

To compare the prevalence of BDD symptoms between patients with different dermatological conditions and healthy skin controls and to describe sociodemographic, physical and psychological factors associated with BDD symptoms to identify patients who may have a particularly high chance of having this condition.

METHODS

This observational cross-sectional, comparative multi-centre study included 8295 participants: 5487 consecutive patients with different skin diseases (56% female) recruited among dermatological out-patients at 22 clinics in 17 European countries and 2808 healthy skin controls (66% female). All patients were examined by a dermatologist. BDD symptoms were assessed by the Dysmorphic Concern Questionnaire (DCQ). Sociodemographic data, information on psychological factors and physical conditions were collected. Each patient was given a dermatological diagnosis according to ICD-10 by a dermatologist.

RESULTS

The participation rate of invited dermatological patients was 82.4% on average across all centres. BDD symptoms were five times more prevalent in patients with dermatological conditions than in healthy skin controls (10.5% vs. 2.1%). Patients with hyperhidrosis, alopecia and vitiligo had a more than eleven-fold increased chance (adjusted Odds Ratio (OR) > 11) of having BDD symptoms compared to healthy skin controls, and patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo and bullous diseases had a more than six-fold increased chance (adjusted OR > 6) of having BDD symptoms. Using a logistic regression model, BDD symptoms were significantly related to lower age, female sex, higher psychological stress and feelings of stigmatisation.

CONCLUSIONS

This study reveals that clinical BDD symptoms are significantly associated with common dermatological diseases. As such symptoms are associated with higher levels of psychological distress and multiple unhelpful consultations, general practitioners and dermatologists should consider BDD and refer patients when identified to an appropriate service for BDD screening and management.

Stigmatization in Patients With Psoriasis: A Mini Review

Psoriasis is a chronic and recurrent immune-related skin disease that often causes disfigurement and disability. Due to the visibility of lesions in patients and inadequate understanding of dermatology knowledge in the general public, patients with psoriasis often suffer from stigma in their daily lives, which has adverse effects on their mental health, quality of life, and therapeutic responses. This review summarized the frequently used questionnaires and scales to evaluate stigmatization in patients with psoriasis, and recent advances on this topic. Feelings of Stigmatization Questionnaire, Questionnaire on Experience with Skin Complaints, and 6-item Stigmatization Scale have been commonly used. The relationship between sociodemographic characteristics, disease-related variables, psychiatric disorders, quality of life, and stigmatization in patients with psoriasis has been thoroughly investigated with these questionnaires. Managing the stigmatization in patients with psoriasis needs cooperation among policymakers, dermatologists, psychologists, psychiatrists, researchers, and patients. Further studies can concentrate more on these existing topics, as well as other topics, including predictors of perceived stigmatization, stigmatization from non-patient groups, influence of biologics on stigmatization, and methods of coping with stigmatization.

Psychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis

Psychological stress has long been recognized as a trigger for plaque psoriasis, and preliminary evidence suggests that psoriasis could be associated with alterations in the hypothalamic-pituitary-adrenal (HPA) axis, resulting in impaired cortisol response to stress. This study aimed to investigate psychological stress, anxiety, depression and salivary cortisol in psoriatic patients. A cross sectional study involving 126 adult patients with plaque psoriasis and 116 adult healthy controls was conducted. Demographic, clinical data, Perceived Stress Scale (PSS) and Hospital Anxiety and Depression Scale (HADS) were collected. Cases and controls were asked whether they felt stressed in the last month, whilst psoriatic patients were also interrogated whether they found that psoriasis could have been worsened by stress. Moreover, 54 randomly selected subjects (27 psoriasis patients and 27 controls) underwent salivary cortisol testing at 8 am. PSS, HADS depression and anxiety subscales were significantly higher in psoriatic patients than in controls (17.2 ± 0.6 vs. 15.1 ± 0.8 p = 0.0289), (9.5 ± 0.3 vs. 6.2 ± 0.3 p < 0.001) and (8.2 ± 0.4 vs. 4.2 ± 0.3 p < 0.001), respectively. A higher rate of psoriatic patients reported feeling stress over the last month (45% vs. 19%, p < 0.001), and stress was considered a potential trigger for psoriasis flare-ups in 69% of cases. Psoriasis was strongly associated with higher PSS and HADS scores independently of sex, body mass index, diabetes, hypertension, dyslipidemia, and occupational status. Salivary cortisol was significantly lower in psoriatic patients compared to controls (9.6 ± 0.5 vs. 14.0 ± 1.1 nmol/L, p < 0.001). In conclusion, psoriasis was associated with higher psychological stress, anxiety and depressive symptoms, and with impaired cortisol response to stress.

Illness Acceptance as the Measure of the Quality of Life in Moderate Psoriasis

Introduction

Psoriasis is a chronic disease with intermittent flares and remissions. Each individual perceives the disease, its somatic effects, resultant dysfunction and related problems differently. This attitude is primarily determined by one’s characterological traits and type of illness. A primary response to the diagnosis can be denial, underestimation, acceptance or overestimation of the disease. The aim of the study was to analyze the level of illness acceptance and its effect on the quality of life in moderate psoriasis depending on sociodemographic and clinical characteristics of the patients.

Materials and Methods

The study included 186 patients with plaque psoriasis with Psoriasis Area Severity Index (PASI) scores ≤10. The inclusion criteria of the study were duration of psoriasis >2 years, age ≥18 years, and lack of other somatic or mental disorders during three months preceding the study. The study participants completed the Acceptance of Illness Scale (AIS), Dermatology Life Quality Index (DLQI) as well as an original survey containing questions about their sociodemographic characteristics and information about their disease.

Results

Mean AIS score for the study group was 24.3 pts. Patients older than 40 years presented with lower levels of illness acceptance than younger persons (p = 0.0311). Also, patients’ sex and duration of psoriasis significantly affected the acceptance of the illness, with lower AIS scores found in women (p = 0.0092) and persons with a longer history of the disease (p = 0.0362). Mean DLQI score for the study group was 13.3 pts. A lower level of illness acceptance turned out to exert an unfavorable effect on the quality of life (QOL) in psoriasis (p = 0.0015; R = −0.33).

Conclusion

In this study, patients with psoriasis presented with a moderate level of the illness acceptance, and a significant correlation was found between this parameter and QOL.

Societal impact for patients with psoriasis: A nationwide Swedish register study

Background

Psoriasis is an immune-mediated chronic inflammatory disease having a significant negative health impact. Psoriasis has societal impact; loss of productivity has been estimated at approximately 10% and it may influence the patient's financial status. Relationships between quality of life, disease severity, and cost of care need exploration. Understanding the disease burden is important for health policy and research allocation. Few studies address the research gaps in socioeconomics, comorbidity, and medication use.

Objective

Observing differences in education, income, employment status, marital status, health care consumption, and drug utilization between patients with psoriasis and matched controls.

Methods

Cohort study following socioeconomics and health care consumption for all psoriasis patients from the Swedish patient register. All individuals with a first diagnosis of psoriasis in outpatient or inpatient care from 2002 to 2013 were followed until death, emigration, or end of the study.

Results

Overall, 109,803 patients were included (mean age 51.2 years, 53% women) and matched with 1.08 million controls. The levels of education and income were similar, but the proportion employed was significantly lower for patients with psoriasis. There was a tendency for fewer patients with psoriasis to be married.

Limitations

Generalizability, lack of primary care diagnoses, and lack of early treatments (available from 2005).

Conclusion

Understanding of the socioeconomic impact of psoriasis is extended by showing reductions in employment.

Effectiveness of a structured short intervention against stigmatisation in chronic visible skin diseases: Results of a controlled trial in future educators

Background

Chronic visible skin diseases are highly prevalent, and patients affected frequently report feeling stigmatised. Interventions to reduce stigmatisation are rare.

Objectives

This study aimed to evaluate the effectiveness of a structured short intervention in reducing stigmatising attitudes towards psoriasis in future educators.

Methods

The intervention consisted of four components: (1) self‐reflection, (2) education on skin diseases, (3) contact between participants and a person with psoriasis and (4) practising of knowledge via case studies. A quasi‐experimental, pre–post study design was chosen with a nonrandomized contemporaneous control group that attended regular lessons. The main outcomes were participants' desire for social distance, stereotype endorsement, illness‐related misconceptions and intended behaviour. Intervention effects were analysed using mixed repeated‐measures analysis of variance, with Bonferroni post‐hoc tests for pairwise comparisons.

Results

The sample consisted of 221 students attending vocational training as educators (n = 118 intervention group, n = 103 control group). While no effect of the intervention was found in social distance, small to large effect sizes were observed for intended behaviour (r = .14), illness‐related misconceptions (r = .28) and stereotype endorsement (r = .42). The intervention group reported significantly higher satisfaction with the seminar compared to the control group.

Conclusions

Overall, the short intervention was effective at reducing stigmatising attitudes in future educators. In perspective, revised versions could help in reducing stigmatisation in various demographics and promote patient empowerment by acknowledging and including them as experts on their own behalf.

Patient or Public Contribution

Patient advocate groups were consulted and involved in the superordinate destigmatization research programme and intervention.

Four years stability of type D personality in patients with moderate to severe psoriasis and its implications for psychological impairment

Background

Psoriasis is a systemic auto-inflammatory disease that is related to an increased risk of organic and psychological comorbidities. Type D is a stable personality trait in healthy subjects but there is no data regarding its stability in patients with moderate-severe psoriasis.

Objectives

To assess the stability of type D personality in patients with moderate to severe psoriasis as well as assessing the influence of type D personality on anxiety and depression.

Methods

Prospective cohort study. Forty psoriasis patients with type D personality and sixty-six patients with psoriasis without type D personality were included in the study. Participants completed the DS14 test and HADS at baseline and four years later.

Results

At baseline, the prevalence of type D personality was 37.7% and at week 208 it was 27.3%. The stability of type D personality was higher in patients with an incomplete education level and in those who were separated/divorced or windowed. During follow-up, 15% of patients developed type D personality. Male sex, having topical treatment, the presence of previous depression, anxiety, and high levels of negative affectivity at baseline increase the risk of developing type D personality.

Study limitations

Sample size, psoriasis severity restricted to moderate and severe and all patients being under treatment for psoriasis.

Conclusions

The presence of type D personality varies over time in psoriasis patients. Therefore, type D personality is possibly more a state than a trait phenomenon, modified by environmental factors. Type D personality is associated with a higher risk of anxiety.

Development and preliminary validation of the patient-reported Chronic Itch Burden Scale assessing health-related quality of life in chronic pruritus

BACKGROUND

Chronic pruritus (CP) significantly affects patients' health-related quality of life (HRQoL). Very few self-reported HRQoL questionnaires exploring CP have been developed according to international guidelines, thus limiting their use in preauthorization trials.

OBJECTIVES

To develop a self-reported HRQoL questionnaire in patients with CP owing to psoriasis, atopic dermatitis, seborrhoeic dermatitis of the scalp or idiopathic dermatitis, and to explore the preliminary psychometric properties of the questionnaire.

METHODS

The study was performed in France. A conceptual framework was developed based on a structured literature review and expert insight, and was improved using three focus groups involving 19 participants. A 50-item questionnaire was created and tested with 21 participants using cognitive debriefings; 11 items were removed. A cross-sectional study including 251 participants was performed to explore the preliminary psychometric properties of the 39-item questionnaire. Dimensionality was explored using principal component analysis. Cronbach's alpha and correlation coefficients (interitem, item-total score and item-dimension score) were measured. The number of items was reduced through expert consensus.

RESULTS

In the 39-item version, three main dimensions were identified (Cronbach's alpha = 0·94) and all correlation coefficients were > 0·34. Upon review, 13 items were deleted owing to poor quality and six items were deleted by the team, generating a 20-item version. The questionnaire's factorial structure was best reflected with a two-dimension solution, i.e. (i) social and emotional repercussions and (ii) relation to others, fear of judgement.

CONCLUSIONS

The Chronic Itch Burden Scale patient-reported questionnaire explores broad aspects of HRQoL that are relevant for patients with various skin diseases. Its good cross-sectional validity makes it useful for trials and practitioners.

Development of a shared decision-making tool in vitiligo: an international study

BACKGROUND

Shared decision-making tools (SDMt) are visual tools developed to promote joint medical decisions between physicians and patients. There is a paucity of such tools in dermatology.

OBJECTIVES

To develop and validate a SDMt for use in specialized consultation for vitiligo.

METHODS

A prospective cross-sectional study was carried out from March 2019 to March 2020. We first conducted a qualitative study of topics discussed by patients and clinicians during therapeutic decision-making in the setting of a specialized consultation for vitiligo using an anchored-theory method, which allowed conceptualization of the SDMt. The usefulness of the SDMt was evaluated by a working group of multidisciplinary health workers and patients with vitiligo. Consensus on the final tool was obtained through an e-Delphi method.

RESULTS

We recruited 30 patients with vitiligo for the qualitative study, which identified 91 topics related to therapeutic decision-making. Hierarchical clustering analysis confirmed the distribution of these topics in two subgroups (general treatment goals and priorities, and topics specific to each treatment). The consensus of a multidisciplinary group was used to develop the SDMt. The tool was comprised of eight A5 cards, which addressed face repigmentation; body repigmentation (limited area); body repigmentation (extended area); partial or complete depigmentation; coping with the disease; stabilization of disease; maintaining repigmentation; and disease information. Cognitive interviews confirmed the satisfaction, readability and usefulness of the SDMt. The SDMt was then translated and culturally validated in English.

CONCLUSIONS

We developed a tool for shared decision-making in nonsegmental vitiligo, which we translated and cross-culturally validated in a US patient population with vitiligo to ensure its generalizability.

Effect of Disease Severity on the Quality of Life and Sense of Stigmatization in Psoriatics

INTRODUCTION

Psoriasis is a chronic inflammatory disease of the skin having a profound effect on the quality of life and contributing to the sense of stigmatization in the affected patients. The aim of this study was to analyze the effect of psoriasis severity on the quality of life and sense of stigmatization in psoriatics and to investigate relationships between these measures and sociodemographic variables.

PATIENTS AND METHODS

The study included 111 patients with psoriasis. The inclusion criteria of the study were the diagnosis of psoriasis and written informed consent to participate. The study was based on a short survey prepared by the authors and four validated scales: Dermatology Life Quality Index (DLQI), 6-item Stigmatization Scale, 33-item Feelings of Stigmatization Questionnaire, and Psoriasis Area and Severity Index (PASI).

RESULTS

Mean PASI score for the study group was 14 pts. Most respondents presented with low DLQI scores, with the mean value of 10.8 pts suggesting that the disease-related ailments were not extremely burdensome for the majority of the patients. Mean stigmatization scores for the 6- and 33-item scale were 7-8 and 81-82 pts, respectively.

CONCLUSION

The severity of psoriasis was the strongest determinant of the quality of life measured with the DLQI. Also, the levels of stigmatization determined with the 6- and 33-item scale correlated significantly with PASI scores.

Epidemiology of psoriasis in the Russian Federation according to the patient registry

Background. Psoriasis is a chronic skin disorder that impairs patients health-related quality of life. It is associated with patients need in specialized medical care and with essential medical costs. Psoriasis may be the reason for temporary or permanent disability. Patient registries are important sources of epidemiological and clinical data on patients with psoriasis and medical care provided. Aims. To describe demographic characteristics, characteristics of the disease, prevalence of concomitant and past diseases in adult (18 years and older) patients with moderate and severe psoriasis included in the patient registry of the Russian Society of Dermatovenereologists and Cosmetologists. Materials and methods. The data of 3,268 patients with psoriasis aged 18 years and older were analyzed as of inclusion in the registry. Data lock point was June 3, 2021. Descriptive statistics methods were applied in data analysis. Results. The mean ( SD) age of adult patients at inclusion in the registry was 46.1 14.4 years. Male patients accounted for 60.5%. The mean age of onset of psoriasis is 31.1 16.1 years. Most of the patients (89.5%) have psoriasis vulgaris. The mean body surface area at inclusion was 43.3% 24.7%. 28.9% of patients had psoriatic arthritis at inclusion in the registry. A high prevalence of cardiovascular diseases was revealed: arterial hypertension 28.5%, coronary heart disease 5.4%, myocardial infarction and acute cerebrovascular accident 0.9% each. More than half of patients are pre-obese or obese according to the WHO body mass index classification. 2.2% of patients have impaired glucose tolerance, 6.7% of patients have type 2 diabetes mellitus. 3.8% of patients have diseases or dysfunction of the thyroid gland. The prevalence of diseases of the digestive system is high: any disease of the esophagus, stomach and duodenum was noted in 10.2% of patients, any disease of the liver, gallbladder, biliary tract and pancreas in 11.8% of patients. The prevalence of viral hepatitis C among patients with psoriasis was 2.6%. Conclusions. The prevalence of comorbidities is high among Russian patients with moderate and severe psoriasis.

Stigma in visible skin diseases - a literature review and development of a conceptual model

The burden of visible skin diseases (VSDs) includes not only physical symptoms but also psychosocial consequences such as depression, anxiety, impaired quality of life and low self-esteem. Stigmatization was shown to play a major role in people with skin diseases. The aim of the study was to review the evidence for the components, drivers and impacts of (self-)stigma, and to organize the data into a series of conceptual models. A targeted literature search was conducted to identify studies on (self-)stigma in relation to VSD. Conceptual models of stigma in VSDs were developed from existing generic conceptual models for VSD and of generic conceptual models of stigma and were refined after discussion with a board of experts, patient advocacy groups, clinicians and researchers. A total of 580 references were identified, of which 56 references were analysed and summarized. Two conceptual models of stigma were identified: one with external stigma and self-stigma dimensions, the other for self-stigma in mental health. These models were adapted to allow a complete description of stigma in VSDs. For this, a distinction was made between 'discrimination' and 'impact'. Finally, five models were developed: macro-overview; stigma, impact and socio-demographics; stigma, impact and disease characteristics; stigma, impact and quality of life; and stigma, impact and coping. Gaps were identified in available quantitative evidence. To our knowledge, this is the first conceptual model of stigma in VSDs. The model will help to standardize evaluation of stigma and to enhance empirical evaluation of anti-stigma interventions in VSDs. Further research should be conducted to develop a more complete model in stigma due to significant gaps in existing evidence, particularly including the stigma in others (external stigma) and also to cover a broader range of VSDs as their impact on particular dimensions of stigma differs.

People-centered care for psoriasis and urticaria: Are we overlooking Internet addiction while only considering patients and physician settings?

Psoriasis and chronic urticaria (CU) are chronic skin diseases with a high impact on individuals' life and mental health. Some studies indicate a high prevalence of Internet addiction and many affected individuals seem not to utilize healthcare, but rather search for health-related information online. The aims of the study were to assess Internet addiction as a potential comorbidity in both diseases as well as identify differences in healthcare utilization between individuals with psoriasis and CU. This cross-sectional study is based on self-reported data from individuals with psoriasis and CU living throughout Germany using the framework of an online survey from 12/2018 to 01/2019. Advertisements on Google and Facebook were used to address Internet users who searched online for information on psoriasis or CU. The study questionnaire comprised questions on demographics, current contact with physicians, and disease history as well as validated screening tools for well-being and Internet addiction. Overall, 1686 participants (74.0% female, 38.5% psoriasis) with a mean age of 36.9 ± 12.9 years were analyzed. Participants with CU were more likely female (89.2% vs 49.8%, P < 0.001) and not in medical care compared to participants with psoriasis (60.3% vs 45.9%, P < 0.001). Sixteen percent of the participants overall were screened positive for Internet addiction. Furthermore, not utilizing medical care showed a significant association with being screened positive for Internet addiction in participants with CU (adjusted odds ratio [aOR] = 1.49, 95% confidence interval [CI] 1.10-2.02), but not in those with psoriasis. The study revealed a high proportion of affected individuals not being in medical care and a high prevalence of Internet addiction, with individuals with CU not utilizing medical resources having a higher chance of being screened positive for Internet addiction. This underlines the approach of people-centered care and highlights its importance for further research.

Attitudes Towards Appearance and Body-Related Stigma Among Young Women With Obesity and Psoriasis

The goal of this study was to investigate the role of the subjective assessment of one's body image in the relationship between objective indices of appearance and perceived stigma in young women affected by obesity and psoriasis. These are chronic diseases that decrease one's physical attractiveness and are associated with stigmas related to body defects. A total of 188 women in early adulthood took part in the study (M = 25.58; SD = 2.90), including obese women (n = 54), women suffering from psoriasis (n = 57), and a control group (n = 77). The participants completed the Multidimensional Body-Self Relations Questionnaire, Perceived Stigmatisation Questionnaire, and a socio-demographic questionnaire. Anthropometric data were gathered using a body composition analyzer. Objective parameters of body shape were calculated (WHR and ICO). Subjective assessment of one's body and attitudes towards one's body were found to influence perceived stigma, independently of the condition causing the stigma and of the objective appearance of the participant. This study did not support the existence of a relationship between parameters regarding body shape and sense of stigma, even when subjective body assessment acted as a moderator. At the same time, body mass was a strong predictor of levels of perceived stigma. Women affected with obesity perceived a higher level of stigma than the other groups. The severity of psoriasis did not impact the perceived stigma. Moreover, women with psoriasis assessed their health-as a part of the assessment of their bodies-the highest, which may explain the lower perceived stigma in this group.

Feeling of stigmatization and satisfaction with life among Arabic psoriatic patients

BACKGROUND

Satisfaction and stigmatization are experienced differently in different cultural contests, especially, in patients with dermatological diseases affecting visible body parts. Reports in Arabic countries remain rare and very appealing in a multicultural population.

AIMS

To evaluate feeling of stigmatization and satisfaction with life in Arabic patients with psoriasis and identify predictors of feeling of stigmatization and satisfaction with life.

METHODS

In a cross-sectional study design, Arabic patients with psoriasis completed the 6-item stigmatization scale and the satisfaction with life scale. Univariate and forward stepwise multivariate linear regression analyses were used to identify predictors of feeling of stigmatization and satisfaction with life. Covariates included patients' demographics (age, gender and education level), disease-related factors (disease severity, visibility, duration, and impact on quality of life) and patient-related factors (illness acceptance and dermatology self-care education level).

RESULTS

In total, 199 Arabic psoriatic patients were included in the study. Despite feeling highly stigmatized by their skin disease [mean (95% Confidence Intervals (CI)) of 7.0 (6.3-7.7)], psoriasis patients were generally positive about their overall satisfaction with life (mean (95% CI) of 21.0 (20.0-22.3). Impaired quality of life was the strongest predictor of both higher feeling of stigmatization (β-coefficient 0.39, 95% CI 0.30, 0.47) and less satisfaction with life (-0.36, 95% CI -0.53, -0.20). Higher levels of dermatology self-care education significantly predicted a lower feeling of stigmatization (-0.09, 95% CI -0.16, -0.01). Older patients (0.18, 95% CI 0.05, 0.30) and those with higher illness acceptance levels (0.14, 95% CI 0.03, 0.24) were more satisfied with life.

CONCLUSIONS

A level of stigmatization was detected in most psoriatic patients including the satisfied ones. Patients with more impaired quality of life experienced higher level of stigmatization and less satisfaction with life. These findings further enforce the multidisciplinary approach in psoriatic patients and highlight the unmet need to include psychologist in the therapeutic algorithm.

The Sense of Stigmatization in Patients with Plaque Psoriasis

BACKGROUND

Psoriasis is a systemic inflammatory disease capable of creating stigmatization in the form of social exclusion and decrement of psychological conditions.

AIM

The aim of the study was to determine the level of stigmatization in patients with plaque psoriasis.

METHODS

The study included 166 patients with plaque psoriasis (55.6% women and 44.3% men) with Psoriasis Area and Severity Index scores ≤10. The age of the study patients ranged between 18 and 72 years (arithmetic mean = 37.4; median = 38; standard deviation [SD] = 11.0). The mean age at the diagnosis of psoriasis was 21.5 years (median = 20; SD = 9.1) and disease duration varied from 2 to 59 years (arithmetic mean = 15.8; median = 15; SD = 11.3). The study patients completed the Polish version of the 6-item Stigmatization Scale and the 33-item Feelings of Stigmatization Questionnaire and a survey developed by the authors of this study, containing questions about the participants' sociodemographic characteristics (sex, age, place of residence, marital status, education, employment status) and information about their disease (location of psoriatic lesions, time elapsed since the diagnosis of psoriasis).

RESULTS

The mean score for the 6-item Stigmatization Scale for the whole study group was 7.6 out of 18 points (median = 7; SD = 3.8; minimum = 0; maximum = 17). The average score for the 33-item Stigma Feelings Questionnaire in our series was 84.5 out of 165 points (median = 88; SD = 20.9; minimum = 30; maximum = 136). A statistically significant sex-related difference was observed in the 6-item Stigmatization Scale scores, with higher stigmatization levels found in men than in women (p = 0.0082). Moreover, significantly higher levels of stigmatization were observed in countryside dwellers (p = 0.0311) and unmarried persons (p = 0.0321). Patients with a longer history of the disease (≥15 years) scored significantly higher on the 6-item Stigmatization Scale (p = 0.0217) than those in whom psoriasis lasted less long, and presented with higher, at the threshold of statistical significance, scores for the 33-item Feelings of Stigmatization Questionnaire.

CONCLUSIONS

Stigmatization awareness should be promoted among physicians and psoriatic patients to improve psoriasis management.

Social awareness about psoriasis: Misconceptions, negative prejudices and discriminatory behavior

Psoriasis patients experience negative attitudes and behaviors exhibited by people who have insufficient knowledge about psoriasis. In this study, the knowledge level of the society about psoriasis; people's attitudes toward such patients were investigated. A questionnaire that investigates the knowledge, attitudes, and behaviors related to psoriasis according to age, gender, and education levels was applied to the participants. About a quarter of participants in the study did not have any knowledge about psoriasis, 22.9% participants who thought that they knew about psoriasis believed that psoriasis was an infectious disease, 34.2% indicated that they were afraid of shaking hands with patients who had psoriasis, 45.4% did not wish to eat any food prepared by such patients, and 13.4% did not want to work with them in the same workplace. Female participants were more concerned that psoriasis was contagious (P = .030) than male participants, and they were more concerned about shaking hands (P = .022) and eating food prepared by psoriasis patients (P = .009). Both the psoriasis is little known and the level of knowledge of the participants who think they have knowledge about psoriasis was insufficient and prejudiced attitudes and behaviors are common in patients with psoriasis.

Emotions, Alexithymia, and Emotion Regulation in Patients With Psoriasis

Psoriasis is a chronic dermatological condition that is frequently associated with problematic patterns of emotional reactivity (the way in which patients react to stimuli), alexithymia (their ability to recognize and label the emotional reaction), and emotion regulation (the ability to enhance or reduce their own emotional reaction). A research in the peer-reviewed scientific literature was conducted in order to identify articles describing the association of psoriasis and affective problems. In particular, we first evaluate studies that have investigated abnormal emotional reactivity (in terms of duration, frequency, or type of the experienced emotions) and its impact on patients' quality of life; next, we review the role of alexithymia and emotion regulation in modulating the relationship between emotional reactivity and quality of life in this population. From a critical analysis of the reviewed studies, we highlight that altered emotional processing might be particularly important in the characterization of this condition. In particular, we show that this condition is related to an emotional reactivity characterized by negative emotions that have a stronger impact on patients' quality of life when emotion regulation abilities are weak, especially if patients have alexithymia. Finally, we present suggestions for future directions in both clinical and research fields.

Internalized Stigma in Pediatric Psoriasis: A Comparative Multicenter Study

Background

Internalized stigma, adoption of negative attitudes and stereotypes of the society regarding persons' illness, has not been studied previously in pediatric psoriasis patients.

Objective

We aimed to investigate the internalized stigma in pediatric psoriasis patients and to determine differences according to factors affecting internalized stigma compared to adult psoriasis patients.

Methods

This multicenter, cross-sectional, comparative study included 125 pediatric (55 female, 70 male; mean age±standard deviation [SD], 14.59±2.87 years) and 1,235 adult psoriasis patients (577 female, 658 male; mean age±SD, 43.3±13.7 years). Psoriasis Internalized Stigma Scale (PISS), Dermatology Life Quality Index (DLQI), Perceived Health Status (PHS), and the General Health Questionnaire (GHQ)-12 were the scales used in the study.

Results

The mean PISS was 58.48±14.9 in pediatric group. When PISS subscales of groups were compared, the pediatric group had significantly higher stigma resistance (p=0.01) whereas adult group had higher scores of alienation (p=0.01) and stereotype endorsement (p=0.04). There was a strong correlation between mean values of PISS and DLQI (r=0.423, p=0.001). High internalized stigma scores had no relation to either the severity or localization of disease in pediatric group. However, poor PHS (p=0.007) and low-income levels (p=0.03) in both groups, and body mass index (r=0.181, p=0.04) in the pediatric group were related to high PISS scores.

Conclusion

Internalized stigma in pediatric patients is as high as adults and is related to poor quality of life, general health, and psychological illnesses. Unlike adults, internalized stigma was mainly determined by psoriasis per se, rather than disease severity or involvement of visible body parts, genitalia or folds.

Stigmatization and Quality of Life in Patients with Psoriasis

Introduction

Each dermatological condition associated with the presence of visible skin lesions can evoke the following psychological response of the patient: shame, anxiety, anger, or even depression. Psoriasis may additionally be a cause of social rejection, which significantly impairs a patient’s private life and social functioning, and may contribute to stigmatization, alienation, and deterioration of their quality of life. The aim of the study was to determine the level of stigmatization and the quality of life of persons with psoriasis in relation to sociodemographic characteristics.

Methods

The study, which included 166 patients with plaque psoriasis, was carried out with the 33-item Feelings of Stigmatization Questionnaire, Dermatology Life Quality Index (DLQI), and a dedicated sociodemographic survey.

Results

Compared with women, men had higher stigmatization scores in the “Feeling of being flawed” domain (p = 0.0362), and patients up to 30 years of age scored higher on the “Guilt and shame” domain (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\bar{x}$$\end{document}x¯ = 17.1 points) than those older than 30 years (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\bar{x}$$\end{document}x¯ = 14.6 points). Also, persons with visible skin lesions presented with higher stigmatization levels in the “Guilt and shame” domain than those without (p = 0.0028). Quality of life in persons with psoriasis did not depend on sociodemographic parameters but correlated significantly with two stigmatization domains, “Sensitivity to the opinions of others” (R = 0.31; p = 0.0030) and “Positive attitudes” (R = 0.27; p = 0.0115).

Conclusions

As stigmatization is a social problem, only greater social awareness of psoriasis may contribute to better understanding and broader acceptance of patients with this dermatosis. To help them to cope with the stigmatization and hence to improve their quality of life, persons with psoriasis should be provided with psychological counselling.

What is new in the psychology of chronic itch?

Itch is often regarded as unpleasant or bothersome and is accompanied by symptoms of distress and impairments in daily life. The biopsychosocial model of chronic itch describes how psychological factors can contribute to the improvement or exacerbation of chronic itch and related scratching behaviour. Recent research underlines the important role of cognitive-affective information processing, such as attention, affect and expectancies. This may not only play a role for acute itch states, but may particularly apply to the process of itch chronification, for example, due to the vicious cycle in which these factors shape the experience of itch. The present paper focuses on new insights into the relation between itch and the cognitive-affective factors of attention, affect and expectancies. These factors are thought to play a possible aggravating role in itch in the long term and have received increasing attention in the recent empirical literature on maintaining and exacerbating factors for chronic physical symptoms. Possible psychophysiological and neurobiological pathways regarding these factors are discussed, as well as possible intervention methods.

Perspectives On Perceived Stigma And Self-Stigma In Patients With Hidradenitis Suppurativa

Objective

To review current knowledge on how patients with hidradenitis suppurativa (HS) experience stigmatization, as well as on its associations with clinical and psychosocial characteristics of the disease. A better understanding of these may help dermatologists improve screening and management for the benefit of HS patients.

Methods

A MEDLINE search using the terms stigmatization, perceived stigma, self-stigma, and HS/acne inversa.

Results

Stigmatization is common among HS patients and has a strong psychosocial impact, which is often disproportional to the extent and severity of skin involvement. Stigmatization in HS has many faces and it is more prevalent and more severe than most other skin diseases. Stigmatization of HS patients is due not only to the distressing symptoms of pain, itch malodorous discharge, and disfiguring scars but also to the lack of knowledge about HS on part of the general public.

Conclusion

Stigma is a significant contributor to the impairment of quality of life and psychiatric co-morbidities commonly seen in patients with HS. Therefore, evaluation for stigma and formulation of strategies to prevent stigmatization and treat its consequences, in the context of a multidisciplinary approach, may ameliorate considerably the lives of HS patients.

[Is the Bavarian Population Open for Teledermatology? A Cross-Sectional Study in Rural and Urban Regions of Bavaria, Germany]

AIM

Teledermatology has a great potential to improve dermatologic care in rural regions. The aim of this study was to assess the willingness to use teledermatology in the rural population of Bavaria, Southern Germany, and to explore major concerns regarding teledermatology.

METHODS

The data of this cross-sectional study were collected both as part of a health survey conducted in the Bavarian forest region in Q1/2017 and as part of a follow-up survey (Q1/2018) of a running cohort study recruited at a Bavarian agricultural festival. Study participants were asked in a standardized questionnaire whether they would send pictures of skin rashes or other skin changes to their dermatologist via the internet, and if "no", why not.

RESULTS

Data on 1,116 participants living in Bavaria were analysed (mean age 50.2 years, 57.3% female, 80.4% living in rural regions). Of the whole sample, 36.6% were willing to use teledermatology. Women, older participants and participants living in rural regions were less open to the use of teledermatology. Major concerns regarding teledermatology were impersonality, doubts about the quality of the service and data safety and privacy concerns.

DISCUSSION

The willingness to use teledermatology in the rural population of Bavaria is still rather low. Before teledermatology can realise its full potential for improving health care in rural regions, the population needs to be educated about the functioning and the advantages of teledermatology, and data safety concerns need to be addressed.

Stigmatization in Arabic psoriatic patients in the United Arab Emirates - a cross sectional study

Introduction

Stigmatization is the phenomenon of labeling negatively people who differ from social norms in some aspect. It seems to be a common and important problem in dermatology. Psoriasis, being a chronic and recurrent skin disease, is frequently associated with various psychosocial consequences.

Aim

To evaluate the stigmatization level in an Arabic population of psoriatic individuals.

Material and methods

A total of 108 consecutive patients suffering from psoriasis were enrolled in the study. All recruited subjects were of Arabic origin. Severity of psoriasis was documented with the Psoriasis Area and Severity Index (PASI). Stigmatization was assessed with validated Arabic language versions of the 6-item Stigmatization Scale and the Feelings of Stigmatization Questionnaire. Moreover, all patients were asked to complete the Dermatology Life Quality Index (DLQI) questionnaire.

Results

The majority of patients showed feelings of stigmatization due to psoriasis. The mean level of stigmatization was 5.6 ±4.5 points assessed by the 6-item Stigmatization Scale and 98.4 ±26.4 points by the Feelings of Stigmatization Questionnaire. Positive attitudes and feeling of being flawed were the most bothersome aspects of stigmatization expressed by patients. Involvement of the face appeared to be the only independent factor influencing the stigmatization level. In the Feelings of Stigmatization Questionnaire, itching was found to be a factor responsible for feelings of stigmatization.

Conclusions

Our study indicated that stigmatization is common among psoriatic Arabic patients. We postulate that measurement of stigmatization level could contribute to the holistic therapeutic approach of psoriatic patients.

Translating the WHA resolution in a member state: towards a German programme on 'Destigmatization' for individuals with visible chronic skin diseases

BACKGROUND

Even today, a substantial number of individuals with visible skin diseases still suffer from incomprehension and stigmatization. About 10 million people are affected by such diseases in Germany. The WHO strongly urges member states to take measures against stigmatization in skin diseases.

OBJECTIVES

Objectives are the development of an action programme to raise awareness and address stigmatization. Therefore, conception, development and testing of interventions for the destigmatization of persons with skin diseases in Germany will be carried out.

METHODS

A series of actions addressing decision makers, politicians and the Federal Ministry of Health were initiated, all based on the World Health Assembly (WHA). Argumentation was largely based on data from health services research. Supported by the Federal Ministry of Health, a concept against stigmatization was developed by an expert consortium of researchers, dermatologists and patients. Specific strategies of structured destigmatization between those affected and those not will be developed and scientifically evaluated.

RESULTS

The activities addressed to politics were - to a large extent - successfully and financially supported by a 3-year programme (2018-2020), designed to develop interventions against stigma. It was funded by the Federal Ministry of Health. The project includes conception and development, intervention and evaluation, data analyses and development of a long-term concept.

CONCLUSIONS

The WHO's call against stigmatization in psoriasis (resolution WHA67.9 and global report on psoriasis 2016) was taken into account and developed into a destigmatization programme supported by the German government and German politicians. This has been achieved by successful collaborations between dermatologists, researchers, patients and policymakers. Next step will be the testing of interventions in situations and surroundings, where stigmatization usually occurs. The data will be used for the implementation of a long-term concept that can be used to continue destigmatization in Germany far beyond the project's initial phase.

Type D personality, anxiety sensitivity, social anxiety, and disability in patients with acne: a cross-sectional controlled study

Introduction

Acne has long been associated with many psychiatric comorbidities.

Aim

To determine anxiety and depression levels, social phobia frequency, social anxiety level, subjective stress perception, anxiety sensitivity, disability, and the frequency of type D personality in patients with acne.

Material and methods

In total, 61 patients with acne aged > 16 years and 61 age, gender, and educationally matched healthy volunteers were included in the study. The patients and healthy controls were evaluated using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria for social anxiety disorder and completed the Liebowitz Social Anxiety Scale, Sheehan Disability Scale, Anxiety Sensitivity Index, Hospital Anxiety and Depression Scale, Perceived Stress Scale (PSS), and Type D Scale-14.

Results

Depression, anxiety, social anxiety, self-reported stress, anxiety sensitivity, and disability levels were significantly higher in patients with acne than in healthy controls (p < 0.05). Type D personality was more prevalent in patients with acne than in healthy controls (49% vs. 18%, p < 0.001).

Conclusions

To our knowledge, this study is the first reported in which type D personality and anxiety sensitivity, as well as social anxiety disorder according to the DSM-5 criteria, was evaluated in patients with acne compared with healthy controls. This study shows that patients with acne have higher levels of depression, anxiety, social anxiety, self-reported stress, anxiety sensitivity, and disability, and a greater prevalence of type D personality, than healthy controls. Psychiatric evaluation of patients with acne may aid the detection of mental disorders.

Stigmatisation and body image impairment in dermatological patients: protocol for an observational multicentre study in 16 European countries

INTRODUCTION

Patients with common skin diseases may have substantial psychosocial comorbidity and reduced quality of life. This study aims at exploring further the psychosocial burden of skin diseases by assessing stigmatisation and body image problems in a large sample of patients with skin disease across Europe.

METHODS AND ANALYSIS

The study is an observational cross-sectional multicentre study across 16 European countries comparing stigmatisation and body image in patients with skin disease compared with controls. Consecutive patients will be recruited in outpatient clinics and will complete validated questionnaires prior to clinical examination by a dermatologist at each recruitment site. In addition to sociodemographic background information, the outcomes will be: mood disorders assessed by short versions of the Patient Health Questionnaire and the General Anxiety Disorder Assessment; general health assessed by the EuroQol-Visual Analogue Scale; stigmatisation experience assessed by the Perceived Stigmatisation Questionnaire; stress assessed by the Perceived Stress Scale and body image assessed by the Dysmorphic Concern Questionnaire. The main criteria for eligibility are to be 18 years old or more. The analysis will include comparison between patients and controls for the main outcomes using t-tests, analyses of covariance and multivariate logistic regression models adjusting for potential confounding factors.

ETHICS AND DISSEMINATION

The study protocol is approved by the University of Giessen and by the local Ethical Committee in each recruitment centre. Informed consent will be given by each participant. The results of the study will be disseminated by publications in international peer-reviewed journals and presented at international conferences and general public conferences. Results will influence support intervention and management of patients with skin disease across Europe.

TRIAL REGISTRATION NUMBER

DRKS00012745; Pre-results.

Depictions of acne and psoriasis influence interpersonal aversion

The presence of a dermatological condition may deter contact with the affected person because it falsely signals the threat of infection. The current study investigated interpersonal aversion towards individuals with the appearance of acne and psoriasis. Participants (N = 196) either viewed a female face with the appearance of acne, psoriasis, or no visible dermatological condition. Participants rated the attractiveness of the person, and indicated their willingness for social and indirect contact with them. The person depicted with acne was rated significantly less attractive than the person with psoriasis or no dermatological condition. Participants reported significantly less willingness for indirect contact with the person depicted with acne or psoriasis compared to the person with no visible dermatological condition. In contrast, participants expressed more willingness for social contact with a person with acne than with the person with psoriasis or no dermatological condition. Group differences were significant when controlling for attractiveness ratings. Unwarranted fear of infection might underpin avoidance and discriminatory behaviour towards those with skin conditions. Further research is required to understand factors that influence avoidance of contact.

Internalized stigma in psoriasis: A multicenter study

Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a person's illness. It causes decreased self-esteem and life-satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross-sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire-12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease.