Skin Care Today

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SKIN CARE TODAY 2017,Vol 3, No 1 5
SKIN CARE MATTERS i
programmes, leading to worsening
symptoms, which in turn may
exacerbate their depression; similarly,
those with obsessive compulsive
disorders are more likely to require
dermatological treatment than
the general public, with repetitive
behaviours actually causing or
exacerbating skin conditions,
including scratching (acne excoriee),
excessive handwashing (irritant
contact dermatitis) and obsessive
hair pulling (trichotillomania).
Similarly, stress can make people
more aware of symptoms such as
itch (hypervigilance), leading to
excessive scratching and feelings of
helplessness or guilt.
Psychological disturbance is not
simply a problem in adults; skin
conditions can also be a significant
factor in children’s mental health,
even acting as a predictor of whether
they will go on to experience
psychological difficulties in the
future (‘Children with eczema at
increased risk of mental problems’—
).
A 2016 study by Pavel
Chernyshov, highlighted three main
developmental periods crucial to
the formation of self-perception and
stigmatisation in patients with atopic
dermatitis, one of the commonest
skin diseases (‘Stigmatization
and self-perception in children
with atopic dermatitis’— www.
researchgate.net):
` Early infancy until three years
of age: children’s psychological
development is affected by
a cycle where severe atopic
dermatitis results in parental
distress and exhaustion, which
then leads to exacerbation of the
child’s symptoms and subsequent
psychological problems
` Three to ten years of age:
children are often affected by
teasing and bullying from peers
` From 10 years of age to
adulthood: problems of low self-
esteem begin to dominate in this
period, with children becoming
increasingly pessimistic and self-
critical about their appearance;
this is also the period where
children and young adults may
begin to avoid social contact.
Dermatology care is most definitely
more than skin deep and the issues
discussed within this paper highlight
fundamental aspects of care that
are often not considered or asked
about. The skin is the largest organ
of the body and one we see daily, it
is not an inert covering and should
be given the importance it deserves.
Unfortunately, because the skin is such a
visible organ, it is often dismissed. The skin,
however, tells a story about our health and wellbeing and for
patients with a skin condition it can have a devastating effect. We
live in a world where first impressions of people are often based
on their physical appearance, and if they look different or have
a visible skin condition they frequently encounter negativity and
comments about how they look. They can be subjected to stares,
whispered comments, antagonism, insults, or excluded from normal
social activities. Living with and treating a skin condition is not
a quick fix, regular treatments are needed and when applied to
the skin take time and need monitoring. Again, this aspect of
care is often trivialised by many. For patients, the trivialisation
of their condition, the treatments required, and the negativity
they encounter has a huge impact both on their physical and
psychological well-being.
‘Imagine what it feels like sitting on a full bus and the seat next to
you is the only one left with people standing rather than sit there!’
‘Think what it feels like when your children beg you not to go to
school, open evening or sports day.’
So, when caring for patients of any age with a skin condition, be
mindful of the psychological issues they may be experiencing. Skin
conditions are generally not life-threatening but can most definitely
be life ‘misery-making’. Spend time listening to your patients,
signpost them to appropriate resources highlighted within this
paper, and refer appropriately to ensure they receive timely and
appropriate support, although service provision, as discussed here,
will be variable.
Sandra Lawton, Nurse consultant dermatology, Rotherham NHS
Foundation Trust; Queen’s Nurse
FINDING SOLUTIONS
Unfortunately, dedicated services
for people with skin conditions
and psychological issues are
rare in the UK. A national
survey undertaken by the British
Association of Dermatologists
(BAD) (‘Working party report
on minimum standards for
psychodermatology services 2012’
— ) revealed poor
provision of services, despite the
following findings: