For many chronic health conditions, the physical symptoms
may be burdensome to patients but not visible to the public. However, you can
clearly see when someone is suffering from severe eczema, rosacea or acne.
Across a wide range of skin conditions, dermatologists see that their patients
are embarrassed by the visibility of their skin condition.
“It’s important that we recognize the significance of these
skin conditions and the burden that they have on patients’ lives,” says Dr.
Aaron Drucker, scientist at Women’s College Research Institute (WCRI) and
dermatologist at Women’s College Hospital (WCH). “We need to validate the
patient’s experience and explain that we understand it’s ‘not just a skin
condition’ and we see the impact it is having on their mental health.”
Not only are patients bothered by the appearance of their
skin conditions, the physical symptoms of these conditions also impact their
mental health. Dr. Drucker’s research focuses on atopic dermatitis, commonly
known as eczema, which can cause extreme itch and prevent patients from
sleeping at night.
“We all know that when we don’t get a good sleep and try to
continue our day while exhausted, that we don’t feel well. For eczema patients,
this adds to the mental health burden of these conditions,” adds Dr. Drucker.
In patients with persistent eczema, Dr. Drucker’s research
found a 22 per cent increased risk of suicide. While this risk is not high
enough to warrant widespread screening across this population, it does
highlight how significant the impacts of the disease can be for some patients
and how it affects their quality of life.
Dermatology was one of the first specialities to develop a
quality of life scale – research that Dr. Vincent Piguet, scientist at WCRI and
head of dermatology at WCH, was closely involved with when the scale was
developed at Cardiff University. The Dermatology Quality of Life Index (DQLI)
is a questionnaire used to determine how a skin condition has affected a
patient’s quality of life, with questions like “how embarrassed or
self-conscious have you been because of your skin?”, “how much has your skin
influenced the clothes you wear?” and “has your skin prevented you from working
“Around the time of the first World War, our criteria of
success in healthcare was whether or not the patient lived,” notes Dr. Piguet.
“We’ve come quite a long way since then and now our focus is more about the
quality of our patients’ lives, not just prolonging them.”
The DQLI is used in clinical care to adjust treatments for
patients. It is also used as a metric for research studies and has become a
gold standard in most clinical trials. Mental health conditions such as
depression can be difficult to diagnose with skin conditions, whereas DQLI
scores can be used to measure the broader impacts on quality of life, including
“One of the hallmarks of dermatological conditions is that
they not only affect the body, but also the mind,” adds Dr. Piguet. “For
patients with hidradenitis suppurativa, a chronic, inflammatory skin disease,
symptoms such as pain and discharge can cause damage to patients’ psycho-social
well-being and their ability to perform daily activities.”
Recent research from Dr. Piguet and his colleagues found
that patients with hidradenitis suppurativa (HS), which predominantly affects
women, had a 16.9 per cent prevalence of depression and 4.9 per cent prevalence
of anxiety. These findings indicate that depression and anxiety are common
comorbidities in patients with HS and warrant the development of strategies to
recognize and treat psychiatric comorbidities in patients with HS.
“There is still much more research needed to be done to
explore the relationship between dermatology and mental health, as well as the
prevalence of these psychiatric comorbidities,” emphasizes Dr. Piguet. “By
properly understanding the magnitude of the burden of skin conditions on mental
health, clinicians can develop and implement targeted interventions to improve
overall health in vulnerable populations.”