Self-Stigma's Role in Chronic Skin Conditions

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Those with visible chronic skin diseases face not only physical symptoms but also significant psychosocial challenges, including stigmatization, which can affect their quality of life.¹ Stigmatization includes both social stigma (external) and self-stigma (internal), with existing research predominantly focusing on social stigma. However, both forms of stigma contribute to decreased functioning and psychological distress.²

A recent review aimed to understand self-stigmatization, including body and self-image issues, in individuals with chronic skin conditions. This review is part of the DEVISE project, which seeks to develop and evaluate an online intervention to reduce self-stigma among people with psoriasis, atopic dermatitis, vitiligo, hidradenitis suppurativa, and alopecia areata in Germany. This review is the first to focus specifically on self-stigmatization mechanisms in chronic skin diseases.³

“Our findings highlight how social stigma can contribute to internalized or self-stigma,” Researchers wrote.

Methods

A comprehensive search was conducted across 4 databases, PubMed, OVID, Web of Science, and PsycINFO. Researchers looked for peer-reviewed articles on self-stigma, psychosocial predictors, or correlates related to 5 chronic skin diseases (atopic dermatitis, psoriasis, vitiligo, alopecia areata, and hidradenitis suppurativa). The search, completed in February 2022, had no date restrictions and included articles published in English or German. Titles and abstracts were independently reviewed based on inclusion criteria: (1) studies involving adults with 1 of the 5 skin conditions per ICD-11; (2) measurement of self-stigma or related terms; (3) evaluation of psychosocial factors related to self-stigma; and (4) peer-reviewed articles in English or German. Terms like internalized stigma, self-devaluation, and body dissatisfaction were treated as synonyms for self-stigma.

Results

After removing duplicates, unfitting, and other ineligible texts, 76 articles were included for review. Of these, 41 were excluded due to factors like lack of relevant predictors or mechanisms, 5 qualitative studies were excluded due to their subjective nature, and studies with suspected data splicing were merged. Ultimately, 27 unique studies were included.

The review found that sociodemographic and clinical variables generally did not significantly predict or correlate with self-stigma. While disease severity and duration showed mixed correlations, body surface area and visibility of skin lesions were notably associated with self-stigma in several studies. Researchers stated that sociodemographic factors like age, marital status, and race had minimal impact, and findings regarding gender were inconsistent. Social stigma emerged as a significant factor, according to the review, with strong positive correlations to self-stigma. Psychological distress, including depressive symptoms and anxiety, was also significantly related to self-stigma. Coping strategies, particularly acceptance, and social support were identifiedby researchers as important predictors of self-stigma, with evidence suggesting that greater social support was associated with lower levels of self-stigma.

Conclusion

This review underscores the importance of addressing both psychological and social factors in managing self-stigma in individuals with skin diseases. While sociodemographic and clinical factors were less predictive, researchers found social stigma and psychological distress were significant contributors. The review highlights the potential of psychosocial interventions targeting coping strategies and social support to mitigate self-stigma.

Researchers suggested that future research should aim to refine measurement tools for self-stigma and explore longitudinal designs to establish causality. The review acknowledged limitations such as language restrictions and the predominance of cross-sectional studies. It stated that future studies should continue to investigate these areas and develop targeted interventions to address self-stigma effectively.

References

1. Dalgard FJ, Gieler U, Tomas-Aragones L, et al. The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol. 2015;135(4):984-991. doi:10.1038/jid.2014.530
2. Ongenae K, Dierckxsens L, Brochez L, et al. Quality of life and stigmatization profile in a cohort of vitiligo patients and effect of the use of camouflage. Dermatology. 2005;210(4):279-285. doi:10.1159/000084751
3. Stuhlmann CFZ, Traxler J, Paucke V, et al. Predictors and mechanisms of self-stigma in five chronic skin diseases: A systematic review. J EurAcad Dermatol Venereol. 2024; 00: 1–9. https://doi.org/10.1111/jdv.20314