Associations of Internalized Skin Bias With Age, Adverse Psychopathology, and Health-Related Quality of Life Among Patients With Hidradenitis Suppurativa: A Cross-sectional Analysis

Psychometric properties of the revised internalized skin bias questionnaire

BACKGROUND

The psychological impacts of skin disease are well documented, with patients reporting increased anxiety, depression and poorer quality of life. More recent studies suggest that adverse psychopathology is associated with re-direction of skin-disease-related social stigma towards oneself or internalized skin bias (ISB).

OBJECTIVES

To refine the Internalized Skin Bias Questionnaire (ISBQ) to reflect the construct of ISB with additional skin-specific biases as well as to evaluate its psychometric properties in a diverse sample of individuals with various skin conditions.

METHODS

Two-part observational design including consensus-building surveys among a dermatology expert group and a cross-sectional survey among participants with self-reported dermatological conditions to assess instrument psychometric properties. Eligible participants completed an online survey comprised of the revised ISBQ (ISBQ-R), the Questionnaire on Experiences with Skin Diseases-Short Form (QES-SF), the Dermatology Life Quality Index (DLQI), the Beck Depression Inventory-II (BDI-II) and the Burns Anxiety Inventory (BAI).

RESULTS

Overall, 33 experts participated including 22 (66.7%) dermatologists or dermatology researchers and 11 (33.3%) patients. Except for three items in the first round, all items received high agreement for inclusion from the expert group. The revised survey was completed by 214 participants who identified mostly as female (n = 185; 86.9%), White (n = 182; 85.5%) and non-Hispanic/Latino (n = 200; 93.4%). Adding and modifying new items resulted in an instrument with stronger internal consistency (Cronbach's alpha = 0.92) and a stronger correlation with other existing stigma measures (QES-SF; ρ = 0.72).

CONCLUSIONS

The ISBQ-R is a modified instrument with stronger internal consistency and a stronger correlation with other existing stigma measures. Additionally, the study further expanded upon previous research by exploring a two-factor structure, suggesting that the ISBQ-R could be used as a single- or a dual-factor instrument depending on investigator goals.

Emotional Dysregulation, Hopelessness and Dysmorphophobic Concerns Among Hospitalized Patients with Autoimmune, Inflammatory, and Metabolic Skin Disorders

Chronic disfiguring skin conditions profoundly affect patients' quality of life (QoL) due to their physical, psychological, and emotional consequences. Although the presence of depression and anxiety symptomatology in dermatological patients is well established, the specific roles of emotional dysregulation, dysmorphophobic concerns, and hopelessness in this population require further investigation. This study aimed for the following: (1) to assess symptoms of emotional dysregulation, dysmorphophobic concerns, and hopelessness in hospitalized patients with severe dermatological diseases; (2) analyze whether emotional dysregulation mediates the relationship between dysmorphophobic concerns and hopelessness. A cross-sectional study was conducted with 120 hospitalized dermatology patients. Patients completed standardized measures, including the Emotional Dysregulation Scale (EDs), Beck Hopelessness Scale (BHS), and the Questionario sul Dismorfismo Corporeo "Body Dysmorphic Disorder Questionnaire" (QDC). Disease severity and pain perception were assessed using the Physician Global Assessment (PGA) and the Numerical Rating Scale (NRS). Significant associations were observed between emotional dysregulation, dysmorphophobic concerns, and hopelessness. Emotional dysregulation partially mediated the relationship between dysmorphophobic concerns and hopelessness (indirect effect: b = 0.013, CI [0.004, 0.026]). Higher dysmorphophobic concerns were associated with emotional dysregulation, which, in turn, predicted greater hopelessness. Emotional dysregulation seems to play a critical role in the relationship between dysmorphophobic concerns and hopelessness in dermatological patients.

Psychosocial effects of hidradenitis suppurativa in the literature: A systematic review

OBJECTIVE

Hidradenitis suppurativa (HS) is an inflammatory disorder characterized by painful, deep follicular nodules, abscesses, sinus tracts, and scarring, most commonly presenting in the inguinal, axillary, and anogenital regions.

METHODS

Systematic review.

RESULTS

This condition substantially decreases quality of life in affected individuals, resulting in higher rates of psychiatric disorders including depression, anxiety, suicidality, and substance use. The detrimental effects of HS are well documented by dermatologists, as individuals with HS make up a large proportion of the patients that they see daily. However, it is unclear whether psychiatrists are aware of the degree of psychosocial impairment present in HS patients.

CONCLUSIONS

It is important that those in the field of psychiatry and behavioral medicine are aware of this condition and are comfortable managing it from a psychosocial perspective. This review chronicles the existing literature on the psychosocial effects of HS and assesses the extent to which dermatology journals review these effects in comparison to psychiatry or behavioral medicine journals.

Stigma in vitiligo: associated factors and severity strata of the Patient Unique Stigmatization Holistic tool in Dermatology (PUSH-D) score

BACKGROUND

Vitiligo is the most common cause of skin depigmentation worldwide. Patients with vitiligo may experience stigma and this needs to be addressed.

OBJECTIVES

To evaluate stigma in patients with vitiligo, search for associated factors and establish severity strata for the Patient Unique Stigmatization Holistic tool in Dermatology (PUSH-D) for patients with vitiligo.

METHODS

We conducted a cross-sectional study in ComPaRe Vitiligo, an e-cohort of adult patients with vitiligo. Stigmatization was assessed using the PUSH-D, a recently validated dermatology-specific stigmatization assessment tool. We conducted univariate and multivariable linear regression to identify patient and disease factors associated with the stigmatization. We used an anchor-based approach to define severity strata for the PUSH-D.

RESULTS

In total, 318 patients participated (mean age 49.7 years; 73.9% women). Fitzpatrick skin phototype IV-VI, severe facial involvement (high Self-Assessment Vitiligo Extent Score of the face) and depression (high Patient Health Questionnaire-9 score) were positively -associated with a higher stigmatization score, although this association was weak [r = 0.24 (P < 0.001) and r = 0.30 (P < 0.001), respectively]. PUSH-D cutoff values that best discriminated patients with high and low stigma, as defined by the anchor question, were 13 and 23 (κ = 0.622, 95% confidence interval 0.53-0.71).

CONCLUSIONS

Our study is the first to use a skin-specific stigmatization tool to assess stigma in patients with vitiligo. Creating strata helps to better interpret the PUSH-D in daily practice and may facilitate its use in clinical trials.

Mental health interventions for atopic dermatitis: knowledge gaps, pilot programmes and future directions

Atopic dermatitis (AD) is associated with high levels of psychosocial burden, often resulting in poor mental health outcomes. Despite this association, few studies have evaluated the efficacy of mental health interventions within this population. Utilization of multidisciplinary and peer-led support, in addition to equipping patients with psychological tools, may be beneficial in improving mental health outcomes. Future research is needed to determine which interventions and formats are desired by, effective in and accessible to patients and caregivers with AD.