Life

Learning to be comfortable in you own skin

Most skin diseases aren't life-threatening, but they can be life-altering. Lisa Salmon reports on the new website hoping to improve psychological support for the eight million people in Britain and the north affected

Eczema causes dry, itchy skin and is an extremely common condition

EVEN getting a tiny spot on your face can affect how you feel – so imagine what it's like coping with a real skin disease.

For many of the millions of people in the UK living with a skin disease – such as eczema, psoriasis, vitiligo and acne – often one of the most distressing things is the perceived reaction of others. Even if other people don't actually notice the condition as much as the person with it thinks, the anxiety can be immense.

However, while doctors can be very good at treating the physical elements, evidence suggests that the medical profession isn't as good at dealing with the psychological distress skin diseases can cause.

SKIN SUPPORT

The British Association of Dermatologists (BAD) has created a new Department of Health-funded Skin Support website (skinsupport.org.uk), providing psychological help for people with skin conditions, by bringing together and linking to patient information leaflets, support groups, self-help materials and helplines.

The site also covers general issues that might crop up for people with skin conditions, like how to deal with things at the start of a new relationship, how to talk to others about the condition, coping with stress and anxiety, and building confidence in social situations.

Previously, support and services directed specifically at skin disease patients were "sporadic". The BAD says those that did exist weren't always easy to find, and there was no centralised hub to provide coordinated psychological support resources across all types of skin condition.

ISOLATION AND DEPRESSION

Skin conditions are the most frequent reason for people to consult their GP, and it's not just the physical symptoms that affect people – diseases that are visible, disfiguring or long-term can carry a multitude of psychological and social effects, including isolation and depression.

A 2013 Parliamentary report into the psychological and social impact of skin diseases called for government and NHS action to improve psychological services for skin disease patients, pointing out that skin disease can have a devastating effect on all aspects of people's lives, from schooling, relationships, self-esteem and career choices, to social, sexual and leisure activities.

SUICIDE WOE

Psoriasis alone is linked to 300 suicide attempts annually in the UK, and a 2011 BAD survey revealed that 85 per cent of patients told their dermatologist that the psycho-social aspects of their skin disease were a major component of their illness.

Stress, as well as being a frequent side-effect of skin conditions, is also known to exacerbate symptoms – thus psychological and self-help interventions can be crucial, not only for easing mental distress but for improving many of the physical symptoms.

"Skin diseases can have a devastating impact on people's mental and emotional wellbeing, and the benefits of support are well-known in medical circles," says BAD president Dr David Eedy.

He says few dermatology departments have access to liaison psychiatrists, so self-help can be a vital tool for patients. "The problem is that finding self-help materials can be difficult – patients don't know where to look and resources are available across so many different websites," he adds. "The beauty of the Skin Support website is that it brings together lots of content in one easy-to-navigate place, and it tailors the materials to people's individual skin disease."

VANITY STIGMA

Andrew Thompson, a clinical psychologist at the University of Sheffield, who was a member of the expert panel that helped develop Skin Support, notes that there are gaps in support for people who attend skin clinics with high levels of psychological distress.

"There can be a potential stigma with asking for psychological help for skin conditions, in that some people may feel they don't want to be perceived as vain and complaining about something that's affecting their skin but isn't going to kill them," he explains. "The psychological distress can be because of other people's intrusive reactions to their condition, or bullying. It's not all in people's heads."

Dr Thompson says there are two ways of dealing with this – one is tackling your own reaction to the condition, and the other is dealing with other people's actual reactions.

"There can be a tendency to jump to conclusions, be drawn to the potential threat and make unhelpful skin comparisons between your own and other people's complexions, or think other people are looking at you, when really, they're actually looking through you and thinking about the bad day they've had at work or whatever."

RESPOND TO RUDENESS

When people are rude about your skin, Dr Thompson suggests it can be useful to respond with prepared statements.

"A lot of intrusive comments are curiosity-driven rather than outright rudeness, and that can be satisfied by a very simple statement. If you can rehearse what to say in advance, it can help."

It can also be useful to change the subject, make good eye contact with people, and develop other social skills to show you're not affected by the condition.

Even pretending you're an actor while you're dealing with it can help, he says, and suggests: "You can also think about who's problem is it – the person who's being intrusive, or yours?"

4 COMMON SKIN CONDITIONS

  • Eczema

Atopic eczema is an extremely common skin condition which causes red, dry, itchy skin, which can sometimes develop weeping, blisters, scaling and thickening. It's not contagious and can run in families, and although it can start at any age, it's most common in children, affecting one in every five. Often treated through topical emollients (moisturisers) and sometimes steroids.

:: Psoriasis

Affecting around 2 per cent of the population, psoriasis occurs when skin cells are formed and shed rapidly, in three or four days instead of the normal three to four weeks, causing inflammation. Psoriasis lesions are pink or red, and covered with silvery-white scales. They can itch, split and become painful. The condition can run in families and start at any age, but often has no obvious trigger. It's not infectious and tends to flare-up unpredictably. Topical or oral medications, and sometimes ultraviolet light treatment, can help.

  • Vitiligo

Vitiligo is an incurable skin disorder resulting from the destruction of melanin-producing cells, leading to visible white/pale patches. Although the cause is unknown, there's evidence that stress may play a role. A survey of UK Vitiligo Society members showed that 35 per cent of respondents felt they had poor quality of life, and other studies have shown people affected experience discrimination and intrusive reactions from others.

  • Acne

Acne is a very common skin condition, characterised by blackheads, whiteheads and puss-filled spots. It usually starts at puberty but can continue into adulthood, and varies in severity. The condition is caused by the excess production of oil triggered by sensitivity to certain hormones, plus a failure to shed dead skin cells properly, which clogs up the follicles. In addition, acne bacterium multiply because of the oil build-up, triggering inflammation and spots. Topical or oral treatments can be effective.

  • To find out more about living with a skin condition and support services available, visit skinsupport.org.uk.
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