Helping kids cope with skin diseases
Physical appearance can have a significant impact on the psychosocial health of children and adolescents, especially with identity and self-esteem. Here’s how to help patients with skin diseases and their families develop coping skills.
Among the stressors that can have a significant negative impact on the quality of life of children are skin diseases, particularly those that affect physical appearance such as psoriasis, atopic dermatitis (AD), and acne. In 2002, the psychosocial effect of these three skin diseases was examined in a literature review that found that these skin diseases seriously affected patients’ lives by causing a host of psychological problems, including depression and anxiety.1 Based on the evidence at that time, the investigators concluded that the effect of skin disease on the psychological well-being of patients is underappreciated.
To date, this may still be true for some pediatricians. Although certain pediatricians recognize the importance of skin-related psychosocial issues, Bernard A. Cohen, MD, professor of Dermatology and Pediatrics at Johns Hopkins University School of Medicine, Baltimore, Maryland, says that he doesn’t think it is universally accepted among pediatricians—and it should be. “It is important to involve the pediatrician in the management of an underlying skin problem because of the positive impact it has on developmental and behavioral issues in addition to making the skin better,” he says.
The need for pediatricians to be aware of the substantial negative effects of skin diseases on children is highlighted by the fact that many children under their care will have a skin condition that could contribute to emotional and behavioral problems if not identified and managed. Both AD and acne are among the most prevalent skin conditions in childhood, with AD associated with early childhood and acne associated with older children. Of the children who develop AD, 60% do so in the first year of life and another 30% before age 5 years. It is estimated that about 40% of children who develop AD will carry the skin disease into adulthood. Unlike AD, acne is most common in adolescents, particularly between ages 15 to 17 years, and is estimated to affect 85% of adolescents.2
In another very recent literature review published in 2016 that looked at the psychosocial effects of AD and acne on children’s self-esteem and identity, investigators found that the effect of AD on a child’s quality of life is comparable to the effect of other chronic diseases, such as diabetes and hypertension.2,3 The effect on mental health and social functioning can be even more severe, with data showing that AD has a more severe impact on mental health than diabetes and more severe impact on social functioning skills than hypertension.2,4 For older children, acne has been shown to have a more negative effect on mental health and social function than other chronic conditions such as asthma, arthritis, back pain, diabetes, and epilepsy.2,5
When examining the effect of AD and acne specifically on identity and self-esteem in children, the literature review showed that multiple factors contribute to difficulties in these areas.2 For children with AD, the investigators found little data on the direct impact of AD on identify and self-esteem but found that most studies focused on the development of behavioral problems associated with AD and the effect of AD on activities and relationships. Data on preschool children with AD show that these children have increased dependency, fearfulness, and nighttime sleep disturbances, and that the incidence of behavioral problems, family disruption, and stressed parenting are all significantly greater with these children. Many of these children can develop behavioral problems that affect their sense of identity (ie, some children may see themselves as “outcasts”).
Other important factors contributing to behavioral problems in children with AD include their relationship with authority figures and peers. Data show that parents and other authority figures of children with AD may unwittingly hinder their child’s ability to develop coping skills, and therefore reinforce behavioral problems and identity issues by not exerting sufficient discipline and giving in to their child’s demands.2 In addition, data show that children with AD often feel stigmatized and fear interacting with others, which results in social isolation and poor self-esteem; bullying and teasing also negatively affect self-esteem and self-identity.
For children with acne, studies show a direct link between acne and identify and self-esteem issues.2 Many of these children feel embarrassed by their acne and have problems with low self-esteem, which is exacerbated by reported teasing and bullying from others. Children with severe acne experience these difficulties even more, which often leads to changes in areas that affect their lifestyle and identity (ie, choices they make in dress, activities, hobbies, and schoolwork).