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鈥淏e comfortable in your own skin.鈥�

That鈥檚 easier said than done, at least for people with dermatologic diseases.

In a representative sample of the adult European population, over 80% of participants considered their skin disease to be embarrassing in personal and work life, with up to 20% reporting stigmatization, a recent study suggests.¹

鈥淪everal large studies on different aspects of the burden of skin diseases have been performed; however, the study population was very often constituted by patients recruited in hospitals or clinical centers, thus missing persons with skin diseases who do not undergo a clinical consultation,鈥� first author Paolo Gisondi, MD, Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy, and coauthors noted in the Journal of the European Academy of Dermatology & Venereology.¹

鈥淭he aim of the present study was to evaluate the burden of the most common dermatological diseases of adult patients across Europe, in terms of impact on quality of life, work life, and stigmatization.鈥� 

Assembling a representative sample of the European population

Using the framework of the European Academy of Dermatology & Venereology (EADV) population-based survey on the 鈥淏urden of skin diseases in Europe,鈥� data were collected for this multinational, cross-sectional study via a web-based online survey from November 10, 2020, to August 5, 2021. 

The population consisted of adults aged 18 years or older from the United Kingdom, Switzerland, Norway, and 24 countries in the European Union. Individuals who reported 1 or more skin disease or skin problem in the prior 12 months were included. Patients reporting mole checks, screenings for skin cancer, or unpleasant sensations related to the skin without the presence of a skin disease were excluded. If an individual reported having more than 1 skin disease, the questions were to be answered referring to the more bothersome disease. 

Skin disease negatively affects quality of life

A total of 44,689 individuals (51% women) completed the survey, and 19,915 (43.3%) of these reported a skin disease. Of these, 35.4% reported having 1 skin disease, 24.3% reported 2 skin diseases, 14.1% reported 3 skin diseases, and 26.3% reported 4 or more. Participants reported an average of 3 skin diseases (median 2). Of the nearly 20,000 participants with at least one skin disease, 15,401 reported that the condition or disease was bothersome. 

The Dermatology Life Quality Index (DLQI) was used to assess dermatology-related quality of life. Most people with hidradenitis suppurativa and half with sexually transmitted diseases reported extremely or very much impaired quality of life. A modest to extremely large impact on quality of life was reported by approximately half of participants with chronic urticaria, acne, or alopecia, and in approximately 40% of participants with psoriasis, atopic dermatitis, or skin cancers. 

There was a strong association between the median DLQI score and the number of skin diseases a participant reported. The median DLQI score ranged from 1.0 when only a single skin problem was present, 2.0 for 2 problems, 3.0 for 3 problems, and 8.0 for 4 or more skin problems. 

Approximately half of participants reported difficulty sleeping, feeling tired, and an impact on taking care of themselves. Focusing on stigmatization, 19.2% reported to have been looked at with disgust, 14.5% felt rejected by others because of the skin disease, and 10.8% reported that access to leisure facilities had been refused. A high impact of the skin disease on life was reported by 14.9% of participants, with nearly half reporting a specific problem related to work. The skin condition was considered to be embarrassing in personal and work life by 88.1% and 83% of participants, respectively.

High rates of personal and professional impact, stigmatization, and anxiety/depression were reported by participants with hidradenitis suppurativa. Participants with acne and urticaria reported particularly impaired work life. Patients with chronic urticaria most frequently reported sleep disturbance and tiredness. 

Acne was commonly associated with time requirements for caring for the disease, and side effects of treatment were reported to be especially burdensome in these participants as well as those with urticaria. Stigmatization and feelings of disgust were reported by 40.4% of participants with vitiligo and 38.2% of participants with acne. Anxiety and depression were commonly reported by all participants.

Addressing the high psychosocial burden of skin disease

鈥淚n conclusion, our study highlights the psychosocial burden experienced by people with skin diseases, and the need to address their impact on quality of life and stigmatization in the context of patient management,鈥� the authors concluded in Journal of the European Academy of Dermatology & Venereology. 鈥淚n particular, the impact on work life highlights the need of an early intervention, in order to avoid consequences on the patients' life course.鈥� 

Limitations of this study include the reliance on self-reported diagnoses from participants, the lack of information on the severity of the reported diseases, and the use of single questions to assess the impact of skin diseases on daily life, work life, and stigmatization. Notably, however, the methodology resulted in the ability to reach individuals who do not undergo clinical consultation on a regular basis using a short questionnaire.

Published: February 28, 2024