Quality of Life With a Skin Disease

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.^[1] 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.^[5]

A person’s quality of life is that person’s idea of their physical, social, and mental health state, often considered an outcome.^[6] 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.^[2] 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.^[2]

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.^[9] Failure to meet the expectations of this perfection goal may lead to increased psychological harm, especially in women.^[9] High-quality education of patients about their disease can help patients maintain a sense of control of their disease without increasing their anxiety.^[10]

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.^[4] 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.^[15] 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.^[16] 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.^[17] 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.^[18]

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.