A new patient assessment on the stigma of visible skin conditions is validated


Khaled Ezzedine, EpidermE, Université Paris-Est Créteil (UPEC), Department of Dermatology, CHU Henri Mondor, AP-HP, and researchers conducted a study to find an effective way to assess stigma in people with conditions visible skin. Because the skin is a primary aspect of physical appearance, it plays an important role in establishing interpersonal relationships.

Skin conditions are generally dismissed as cosmetic problems, even though they affect a quarter of the world’s population and are a major cause of disability, according to investigators. Visible skin disorders can have a profound impact on an individual, even if the condition is mild.

Changes in skin color or appearance not only have a long history of misconceptions, but the reactions and behavioral changes of others can lead to social exclusion and isolation, as well as an additional burden on the beyond the physical. To be able to measure the impact of these characterizations of stigma, the team developed a specific dermatological questionnaire.

Understanding the stigma of skin conditions

After the investigators launched a literature search on PubMed, a verbatim record gathered items to be included in the questionnaire based on qualitative interviews with patients living with various dermatological conditions. A study was then set up for the psychometric analysis of the Holistic Unique Patient Stigma Tool in Dermatology (PUSH-D).

Refinement of the dermatology-specific stigma questionnaire consisted of item reduction based on inter-question correlations, expert consensus, and exploratory factor analysis. The PUSH-D questionnaire started with a primary list of 22 items and was reduced to 17.

For validation, investigators calculated Cronbach’s alpha for internal consistency, then the correlation between PUSH-D and the Dermatologic Quality of Life Index (DLQI) and Rosenberg Self-Esteem Scale (RSES ) for concurrent validity.

A new stimulation questionnaire specific to dermatology is validated

According to the study’s analyses, the PUSH-D questionnaire offers a comprehensive perspective on the stigma of visible skin disorders. Additionally, the questionnaire demonstrated the ability to compare degrees of stigma in various skin conditions.

The population studied during the development and validation phase included a total of 2620 patients (57% women) with an average age of 45.14 years. Self-reported disease severity was mostly low (42.9%) and moderate (44.9%), with 9.7% reporting high severity. Skin conditions included were atopic dermatitis/eczema, psoriasis, acne, rosacea, hair loss, aging skin, visible facial scarring, and vitiligo.

Based on exploratory factor analysis, the 17-item questionnaire covers 2 relevant dimensions related to “felt stigma” and “actual stigma”. The results displayed construct validity and PUSH-D revealed reliable internal consistency. The correlation between PUSH-D and DLQI was strong and the relationship with RSES was moderate.

“A dermatology-specific instrument such as PUSH-D is needed to compare the level of stigma across various skin conditions,” the investigators wrote. “It can, of course, be supplemented with a disease-specific instrument for further analysis of quality of life and stigma. It should be mentioned that PUSH-D is a dermatology-specific instrument which is not limited to only visible dermatological diseases, but also includes visible skin conditions such as facial scars and skin aging, both of which are highly stigmatized.

According to the team, there was previously no sufficiently validated instrument available to assess stigma in this specific population.

“This report confirms the feasibility, reliability and validity of PUSH-D as a specific instrument designed to assess stigma in visible skin conditions. With its 17 items and six possible answers for each, this questionnaire is relatively short, understandable and easy to use by patients,” the investigators said.

The study “Patient Unique Stigmatization Holistic tool in dermatology (PUSH-D): Development and validation of a dermatology-specific stigma assessment tool” was published in Eur Acad Dermatol Venereol.


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