gms | German Medical Science

Background and state of (inter)national research: It is well established that the impact of dermatological diseases goes beyond clinical symptoms and often includes psychosocial burden. Self-stigmatization plays a key role in this relationship. However, previous studies have focused either on the experience of stigma in specific diseases or on visible skin diseases in general. This study adds a comparative analysis of self-stigmatization in patients with psoriasis and atopic dermatitis (AD) to the literature and aims to assess the validity of cross-disease stigmatization models.

Research question and objective: Whether and to what extent is a cross-disease model of self-stigma applicable in patients with dermatological diseases?

Method or hypothesis: In total, 101 patients per indication were included in this cross-sectional study. Besides sociodemographic and clinical data such as disease severity, patient-reported outcome measures about self-stigmatization, depression, anxiety, and skin-related quality of life were assessed. The extent and the impact of self-stigmatization were compared using t-tests, and predictors with help of standardized regression coefficients. Sociodemographic and clinical factors were tested on their moderating effects between self-stigmatization and quality of life.

Results: Group mean comparisons yielded no significant differences in self-stigmatization, neither the total score nor any of the subscales did significantly differ. In both diseases, self-stigmatization significantly predicted depression and anxiety symptoms as well as the quality of life. Present symptoms, not having close social relationships, and lower age are associated with self-stigma in patients with psoriasis, whereas the involvement of sensitive body areas, the sum of former treatments, and female gender were predictors in patients with AD. In both groups, symptoms had significantly moderating effects.

Discussion: The results yet again underline the relevance of self-stigmatization in patients with chronic visible skin diseases. The extent of self-stigmatization does not seem to differ significantly between patients with psoriasis and AD. The impact of self-stigmatization on psychosocial well-being is also significant in both diseases. These findings support the validity of approaches that examine self-stigma across dermatological conditions, although the differing strengths of important determinants of self-stigmatization indicate that great caution and sensitivity are needed.

Practical implications: Assessments, conceptual models of self-stigma, and interventions are likely applicable across chronic dermatological diseases. Intervention efforts can be broadened, and sample sizes increased.

Appeal for practice (science and/or care) in one sentence: Uncover the invisible burden of visible diseases.