On the importance of assessing stigma in dermatological research

In this issue of the JEADV, an article by Butt et al.¹ studied the psychometric properties of the revised internalized skin bias questionnaire. As the scientific literature accumulates evidence on the mental burden of skin diseases and the influence of psychological stress on their development, it has prompted a need for dermatological research to increasingly—and inevitably—consider complex psychosocial factors in order to further understand the hidden impact of these visible diseases. Indeed, in addition to being the largest organ, the skin is also the most exposed, and as such, any change in its appearance is likely to be visible. Thus, unlike many other conditions, skin diseases are often immediately noticeable, thereby impacting interactions with others and the environment. This inherent key effect makes the concept of stigma particularly relevant to skin diseases. In a recently published study,² we and others have invested efforts in developing a specific instrument aimed at assessing stigmatization across a relatively wide range of skin diseases in France. Within this context, it is important to recognize the intricacy of stigma. As a result, no single instrument can fully capture all relevant aspects of stigma, making it more challenging to assess this complex psychological construct.³ Furthermore, one should acknowledge that social circumstances and cultural differences pose an additional challenge to the dissemination of these types of instruments on a larger scale, among other barriers that researchers may face.

While integrating these critical processes in health studies is a difficult task, it naturally follows from the obligation to improve therapeutic strategies for (and with) patients according to a more holistic perspective. People with skin diseases were historically excluded from these efforts because common dermatoses were often neglected, but it is now well established that such disorders can lead to significant psychological and social impairments. The current conundrum highlights the necessity of adopting a more person-centred approach in therapeutic planning for skin diseases,⁴ thus widening healthcare providers' perspectives to more than strictly medical interventions. The work of Butt et al. on internalized stigma, or self-stigma, is a needed step towards highlighting the importance of incorporating this critical yet underexplored dimension of stigmatization into everyday clinical practice. Although the authors have explored one of the many facets of stigmatization, there remains a need to explore other dimensions of this important concept, such as enacted stigma. These initiatives should be supported to continue delving into the complex relationships between psychosocial factors and skin diseases. This growing interest in integrating these layered psychological concepts into dermatological assessment will set a new ground beyond skin deep for the everyday care of the ordinary person facing skin disease. Hence, we advocate for further innovative research focused on deepening our understanding of the complex psychological and social ramifications in dermatology. Building and developing effective tools to measure these factors as accurately as possible will help us gain conceptual clarity, ultimately contributing to disseminate a more comprehensive multidisciplinary framework for common skin diseases and potentially impacting many individuals positively.

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