Quality of Life With a Skin Disease
Would people rather have an internal disease instead of one that shows on their skin?
When thinking of a difficult disease that affects mental outlook, many of us think of suffering in silence from chronic disease or the stress of knowing your disease affects your body daily, knowing that eventually, you may die from it. But what if a disease affects the way others look at you? The way others interact with you?
According to Maslow's hierarchy of needs, only once our most basic necessities are me, such as food, water, and shelter, can we begin to start thinking of any self-actualization. However, right after the basic needs are met, the psychological needs are important, such as the need for intimate relationships and friends. While one disease may affect the physiological aspects of the body, another can affect the psychological need for human interaction.
The question in this hypothetical “would you rather” game remains a disease “on the inside” or a disease “on the outside?” The answer is deeply personal, but usually, lies within your perception of control about the condition.[2-4] In life, most often as our sense of independence and control decreases, so does our self-confidence and self-esteem.
A person’s quality of life is that person’s idea of their physical, social, and mental health state, often considered an outcome. This idea has also been described as a “reflection of an individual’s relationship with the environment.”[7,8] In a study of patients with chronic diseases like osteoarthritis, acceptance of their diseases, as well as a personal sense of control of their health, was correlated with a higher quality of life outcome. Patients who often blamed their disease on external factors, such as the environment, felt as if they had lower degrees of control of their diseases. Therefore, they did not as readily accept their disease, leading to a lower quality of life.
When a patient’s disease feels out of his or her control, he or she may spiral down in thoughts of negativity, which can include considerations of suicide. One aspect of control of a disease is the ability to influence others’ perceptions of the disease. For skin disorders such as acne, the patient “wears” the disease on the skin, often for all to bear witness. Our society encourages us to pursue “perfection” and attain the ever-elusive flawless skin. The feeling of helplessness and the frustration may lead to a lower quality of life. Failure to meet the expectations of this perfection goal may lead to increased psychological harm, especially in women. High-quality education of patients about their disease can help patients maintain a sense of control of their disease without increasing their anxiety.
Living with a Chronic Skin Disease
Living with a chronic skin disease such as acne, psoriasis, or eczema has been associated with emotional distress such as insomnia and anxiety. For adolescents, high school is fortunately not forever, but the negative psychological impact of acne, such as social teasing, can lead to difficulties in maintaining relationships.[11,12] While teens may be told to “just ignore” the bullying about looks, the constant injury to their self-esteem may lead to increased risk for suicides.[13,14]
While skin diseases may seem more superficial when compared to the myriad of potential internal diseases, a study in Denmark found that individuals suffering from skin disease have deeper psychological effects. The study discovered that individuals with a skin disease have a lower quality of life than the general population. In studies examining children with chronic skin diseases as well as those with other chronic diseases, both groups had similar negative effects on quality of life. In another study examining patients with chronic disease such as asthma, epilepsy, diabetes, back pain, and arthritis, the psychological and emotional problems were on the same level as those of an acne patient. Another study showed that patients with psoriasis suffered similar impairments on both physical and mental levels to patients with cancer, arthritis, hypertension, heart disease, diabetes, or depression.
In dealing with any chronic disease, a care provider should understand that no matter how insignificant the disease may seem from his or her clinical standpoint, it matters, and it especially matters to the patient.
- Healy K. A Theory of Human Motivation by Abraham H. Maslow - reflection. Br J Psychiatry.2016;208(4):313; PMID: 27036694 Link to research.
- Denys K, Denys P, Macander M, et al. [Quality of life, acceptance of illness and a sense of health control in patients with chronic musculoskeletal disorders during the rehabilitation process]. Pol Merkur Lekarski.2015;38(225):155-158; PMID: 25815616 Link to research.
- Lau-Walker MO, Cowie MR, Roughton M. Coronary heart disease patients' perception of their symptoms and sense of control are associated with their quality of life three years following hospital discharge. J Clin Nurs.2009;18(1):63-71; PMID: 19120733 Link to research.
- Parna E, Aluoja A, Kingo K. Quality of life and emotional state in chronic skin disease. Acta Derm Venereol.2015;95(3):312-316; PMID: 24978135 Link to research.
- B SAaS-H. Quality of life in old age described as a sense of well-being, meaning and value. - PubMed - NCBI. 2017PMID: Link to research.
- Leyendecker B ea. Quality of life of liver transplant recipients. A pilot study. - PubMed - NCBI. 1993PMID: Link to research.
- Robertson G. Individuals' perception of their quality of life following a liver transplant: an exploratory study. J Adv Nurs.1999;30(2):497-505; PMID: 10457253 Link to research.
- L Z. Quality of life: conceptual and measurement issues. - PubMed - NCBI. 1992PMID: Link to research.
- Magin P, Adams J, Heading G, et al. 'Perfect skin', the media and patients with skin disease: a qualitative study of patients with acne, psoriasis and atopic eczema. Aust J Prim Health.2011;17(2):181-185; PMID: 21645475 Link to research.
- Nelson PA, Kane K, Pearce CJ, et al. 'New to me' - changing patient understanding of psoriasis and identifying mechanisms of change: The Pso Well(R) patient materials mixed methods feasibility study. Br J Dermatol.2017;10.1111/bjd.15574PMID: 28403510 Link to research.
- Walker N, Lewis-Jones MS. Quality of life and acne in Scottish adolescent schoolchildren: use of the Children's Dermatology Life Quality Index (CDLQI) and the Cardiff Acne Disability Index (CADI). J Eur Acad Dermatol Venereol.2006;20(1):45-50; PMID: 16405607 Link to research.
- Halvorsen JA, Stern RS, Dalgard F, et al. Suicidal ideation, mental health problems, and social impairment are increased in adolescents with acne: a population-based study. J Invest Dermatol.2011;131(2):363-370; PMID: 20844551 Link to research.
- Gupta MA, Pur DR, Vujcic B, et al. Suicidal behaviors in the dermatology patient. Clin Dermatol.2017;35(3):302-311; PMID: 28511829 Link to research.
- Would You Rather Have Another Disease Other Than Acne:. 2006; Link to research.
- Vinding GR, Knudsen KM, Ellervik C, et al. Self-reported skin morbidities and health-related quality of life: a population-based nested case-control study. Dermatology.2014;228(3):261-268; PMID: 24642860 Link to research.
- Beattie PE, Lewis-Jones MS. A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol.2006;155(1):145-151; PMID: 16792766 Link to research.
- Mallon E, Newton JN, Klassen A, et al. The quality of life in acne: a comparison with general medical conditions using generic questionnaires. Br J Dermatol.1999;140(4):672-676; PMID: 10233319 Link to research.
- Rapp SR, Feldman SR, Exum ML, et al. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol.1999;41(3 Pt 1):401-407; PMID: 10459113 Link to research.