Body image and body dysmorphic concerns

Most people would like to change something about their bodies and the way that they look, but for some it becomes an obsession. A healthy skin plays an important role in a person’s physical and mental wellbeing, whereas a disfiguring appearance is associated with body image concerns. Skin diseases such as acne, psoriasis and vitiligo produce cosmetic disfigurement and patients suffering these and other visible skin conditions have an increased risk of depression, anxiety, feelings of stigmatization and self-harm ideation. Body image affects our emotions, thoughts, and behaviours in everyday life, but, above all, it influences our relationships. Furthermore, it has the potential to influence our quality of life. Promotion of positive body image is highly recommended, as it is important in improving people’s quality of life, physical health, and health-related behaviors. Dermatologists have a key role in identifying body image concerns and offering patients possible treatment options

The ESDAP diploma in psychodermatology

PS26 Psychodermatological consultations are a reality in most European countries nowadays. It is therefore important for health providers to be properly trained to deal with dermatological patients who present with specific needs. Throughout Europe, psychotherapy is being regulated and protected by law and the idea is for this diploma in Psychodermatology to be adapted to current regulations. ESDaP will offer these training courses on an international basis. Each teaching module offered will be the same in different European countries, and offered in different languages by a team of experts coordinated by an ESDaP EC member. The training program will consist of 3 levels. The levels and topics covered are as follows: Level 1: psychodermatologist, skin–psychologist, skin–psychiatrist. Acquiring competences in: doctor–patient relationship and communication skills, alexithymia, anxiety, depression, self-inflicted skin lesions, body dysmorphic disorders, delusion of parasitosis and other delusions, quality of life, psychopharmacological treatment, and psychological interventions. Level 2: Psychotherapeutic level A. Counsellor: first level dermatologist/psychologist/ psychiatrist trained as counsellor in various approaches (Habit reversal, atopy school, etc.) B. Practitioner: the same candidates reaching the requirements for the European Certificate in Psychotherapy Additionally, ESDaP will acknowledge and certify a multidisciplinary consultation dermatologist– psychologist/psychiatrist when one of the consultants reaches Level 2

Screening for body dysmorphic disorder in patients with acne

Body Dysmorphic Disorder (BDD), is a mental health disorder that is difficult to diagnose, causes much suffering and is a challenge to treat. The main symptoms are the preoccupation with the perceived defect and the actions taken to reduce accompanying feelings of distress. Prevalence of BDD is between 9% and 12% in dermatology patients. Although the onset of BDD is usually during adolescence, patients are usually diagnosed after many years of suffering, in part because patients are too ashamed to talk about their symptoms. The main objective of this multicenter study carried out in Spain, was to screen patients diagnosed with acne vulgaris for BDD by asking appearance-specific questions. A total of 403 patients were screened..

Laughter as a diagnostic measure of psoriasis severity

Laughter has been studied for its beneficial effects on health and as a therapeutic method to prevent and treat medical conditions. We explore the predictive potential of laughter as a psoriasis severity diagnostic tool. In this study, the dermatologist first examines the patient and registers the PASI and BSA scores. Then patients complete the DLQI and EQ-5D-3L (quality of life), as well as the HADS (anxiety and depression) and the NEO PI-R (personality traits). Finally, the laughs of 30 patients with plaque psoriasis (15 mild cases and 15 moderate to severe cases), and 30 healthy controls will be registered. To do this, patients and accompanying health controls (in pairs), watch a 15-minute video with humorous sketches..

The psychosocial burden of hidradenitis suppurativa: the patients' perspectives

We designed a qualitative study to interview 12 patients with Hidradenitis Suppurativa. This was done by means of a semistructured interview. Questions on quality of life, the impact of their skin disease on family, friends, work, intimate relationships, treatments, etc. were asked. Patients consented to be interviewed and to be video taped to facilitate the transcription of the interviews. The interviews lasted between 30 and 60 minutes and were carried out by a psychologist and a social worker. The dermatologist had previously seen the patients and filled in a form with the Hurley Stage, years of evolution and treatment..

The use of HSQoL-24 in an assessment of quality-of-life impairment among hidradenitis suppurativa patients: First look at real-life data

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with well-documented effects on patients’ quality of life (QoL). The aim of this study was to evaluate the QoL of patients with HS via the use of a newly developed questionnaire: Hidradenitis Suppurativa Quality of Life-24 (HSQoL-24). This study was performed on a population of 342 HS patients. Their QoL was assessed via the HSQoL-24 questionnaire. The perceived impairment of QoL due to HS in the studied group was considered to be serious (mean HSQoL-24 score: 58.3 ± 21.0 points). Women tended to experience a significantly higher impact from the disease than men (61.6 ± 19.2 points vs. 51.1 ± 23.1 points, p < 0.001). The HS severity had an effect on the perceived QoL, with statistically significant differences being evident between the self-assessed HS severity groups. The level of QoL impairment correlated positively with the number of affected body areas (r = 0.285, p < 0.001) and the duration of the disease (r = 0.173, p = 0.001), while the patients’ age at disease onset correlated negatively with the HSQoL-24 global score (r = -0.182, p = 0.001). Patients living in their family house scored higher than other groups. The least affected were patients who lived alone. The study shows that the HSQoL-24 questionnaire is a reliable, HS-specific tool for measuring the QoL among patients with HS in real-life clinical settings. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

The sociotype questionnaire: assessing the social burden of skin diseases

Skin diseases can cause a significant psychosocial burden. A number of studies have considered issues such as a lower quality of life, increased anxiety, depression, suicidal ideation and other psychological disorders. However, adequate means for evaluating social interaction difficulties, diminished social networks, and the impoverished conversational exchanges that affect the wellbeing and mental health of the individual, have not been sufficiently developed. This study is based on the sociotype approach that has recently been proposed as a new theoretical construct implemented in the form of a questionnaire; it examines the social bonding structures and relational factors associated with dermatological conditions..

Impairment of Sexual Life in 3,485 Dermatological Outpatients From a Multicentre Study in 13 European Countries

Skin conditions may have a strong impact on patients' sexual life, and thus influence personal relationships. Sexual issues are difficult to discuss directly in clinical practice, and a mediated instrument may be useful to capture such information. In this study item 9 of the Dermatology Life Quality Index was used to collect information on sexual impact of several skin conditions in 13 European countries. Among 3,485 patients, 23.1% reported sexual problems. The impairment was particularly high in patients with hidradenitis suppurativa, prurigo, blistering disorders, psoriasis, urticaria, eczema, infections of the skin, or pruritus. Sexual impact was strongly associated with depression, anxiety, and suicidal ideation. It was generally more frequent in younger patients and was positively correlated with clinical severity and itch. It is important to address the issue of sexual well-being in the evaluation of patients with skin conditions, since it is often linked to anxiety, depression, and even suicidal ideation.Peer reviewedFinal Published versio

Efficacy, safety and patient reported outcomes (PROS) in adult patients with atopic dermatitis treated with dupilumab at week-52 in usual clinical practice

P15 Background: Dupilumab, an anti-interleikin-4-receptor-a monoclonal antibody, is a new treatment for atopic dermatitis in adults. Objective: To evaluate – at week 52 – patient reported outcomes, satisfaction, efficacy and safety, with dupilumab in adult patients with moderate-to-severe atopic dermatitis refractory to the usual treatments previously performed under conditions of usual clinical practice. Methods: Twelve patients were enrolled. Patients from our hospital, under routine clinical practice, were treated with subcutaneous dupilumab 300 mg every 2 weeks. The outcomes were evaluated at baseline, week 4, 8, 12, 16, 28 , 40 and week 52. The variables evaluated were: itch, difficulty to sleep, previous stressful life events, severity (SCORAD), anxiety and depression symptoms (HADS), quality of life (DLQI, EQ5D3L), satisfaction, adherence to the treatment, efficacy and safety. Results: At week 52 significant improvement was observed in severity, itch, difficulty to sleep, anxiety and depression symptoms, and quality of life. Satisfaction with dupilumab compared to previous treatments was significantly higher in all aspects assessed. No significant dupilumab-induced laboratory abnormalities were noted, and adverse events were mild and transient. Conclusions: Dupilumab used under routine clinical practice for 52 weeks improved atopic dermatitis signs and symptoms, with a good safety profile and patient satisfaction