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Effect of skin diseases on quality of life is underestimated, reveals pan-European study

The psychological burden and subsequent impact on quality of life of skin diseases such as acne, hidradenitis suppurativa and urticaria has been revealed in a large pan-European study published in the Journal of the European Academy of Dermatology and Venereology (EADV).

Adding to the existing evidence derived from studies in which adult patients have been recruited from either hospitals or clinical centres, the researchers aimed to broaden the evidence base and include people with a wide range of skin diseases who do not undergo a clinical consultation.

Of the 19,015 participants who responded to the ‘Burden of skin diseases in Europe‘ survey, around 50% of participants with acne, alopecia, or chronic urticaria, and about 40% of those with atopic dermatitis, skin cancers, or psoriasis reported a modest to extremely large effect of the disease on their quality of life.

This was particularly impaired in people with hidradenitis suppurativa, with almost 60% reporting that their quality of life was extremely or very much impaired.

Around 50% of participants with acne, alopecia, or chronic urticaria, and about 40% of those with atopic dermatitis, skin cancers, or psoriasis, reported a modest to extremely large effect of the disease on their quality of life.

Some 88.1% considered their condition to be embarrassing in their personal life, and 83% reported the same in their work life.

In addition, 14.5% felt to have been rejected by others because of their skin condition, and 19.2% reported having ‘been looked at with disgust‘. Anxiety and depression were frequently reported by patients with each of the skin diseases studied.

Commenting on the findings, Professor Myrto Trakatelli, chair of EADV‘s advocacy working group, said: ‘Skin diseases are systematically underestimated, and only a small number of interventions on tackling associated stigmatisation have been published.

‘Urgent action must be taken to raise awareness of the impact that skin diseases have on individuals, economies and society and to ensure that patients receive the holistic care they need, including mental health support.

‘Eliminating stigma across the field is of paramount importance to really improve the life of the many patients living with skin diseases, so we call on policymakers to take concerted action to address both the physical and psychological burden of skin diseases.’

Despite their high prevalence and psychological and physical impact, skin diseases receive limited policy, research and funding attention, according to the EADV.

Burden of skin diseases: the findings

Researchers recruited a representative sample of the European general population aged 18 years or older. A total of 19,915 people responded to the survey, with nearly half (44.7%) being male.

When a respondent declared they had experienced one or more skin problems or diseases during the previous 12 months, they completed the Dermatology Life Quality Index questionnaire and answered questions regarding the impact of their skin disease or diseases on their daily and work lives, anxiety, depression, and stigmatisation.

Some 35.4% had only one skin disease, 24.3% reported having at least two, and 26.3% had four or more.

When looking at the specific conditions, patients with hidradenitis suppurativa reported a high level of personal (67.3%) and professional (63.7%) impact, as well as stigmatisation at 35% and 37% for rejection and disgust, respectively.

The impact on work life was a particular problem for those with acne (47.5%) and urticaria (59.7%).

What‘s more, acne was most frequently associated with time requirements to take care of the disease (65.7%) and side effects of treatment were reported to be especially burdensome in patients with acne (50.9%) and urticaria (53.9%).

A high proportion of those with acne and vitiligo reported stigmatisation, in particular feelings of disgust at 38.2% and 40.4%, respectively.

Commenting on the findings, Professor Marie-Aleth Richard, EADV board member and lead author of the research, said: ‘This study highlights the alarming psychosocial challenge faced by individuals with skin diseases and underscores the need to provide psychological support to patients, and to mitigate the stigmatisation that patients endure in their personal and professional lives.

‘With a profound impact on mental health, these common diseases exert a significant toll on patients’ quality of life.’

The EADV states that as ‘the patient journey is frequently complex, with many avoiding medical consultations‘, there will be an ‘underestimated true burden‘.

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