Patients with HS, Eczema Report Decreased Quality of Life Due to Perceived Stigma

Jonathan D. Greenzaid

Credit: LinkedIn

Negative biases may be present towards individuals with hidradenitis suppurativa (HS) and atopic dermatitis, according to new findings, and patients with history of HS or atopic dermatitis may be less likely to maintain stigmatizing viewpoints these skin disorders.¹

These findings were the results of a recent analysis, led by Jonathan D. Greenzaid from the department of dermatology at Wake Forest University School of Medicine in North Carolina.

Greenzaid et al. noted that the stigma associated with HS and atopic dermatitis frequently represents a significant burden for patients. This can result in a negative self-image and greater anxiety and depression rates.^2,3,4

“However, few studies investigate the general public's endorsement of stigmatizing attitudes towards people with cutaneous diseases,” Geenzaid and colleagues wrote. “We aimed to analyze the perception towards individuals with HS and (atopic dermatitis) and evaluate factors leading to higher rates of stigmatization.”¹

Background and Design

Study participants in the age range of 18 years and older were given a survey with 51 inquiries through the Amazon Mechanical Turk (MTurk). For the purposes of enhancing the survey’s reliability, they assigned 4 attentiveness-check questions randomly.

Stigma-associated inquiries were separated into 3 categories: belief in atopic dermatitis myths, desire to social distance, and endorsement of stereotypes. Images of atopic dermatitis and moderate-to-severe HS were presented by the investigators within the research team’s survey they provided to subjects, and subjects’ attitudes toward these skin conditions were assessed.

The subjects ranked the images on a 1–5 Likert scale, with a score of 1 suggesting the most stigmatizing views and a score of 5 suggesting the least stigmatizing. An endorsement of stigmatizing views was indicated by a 1 or 2 score on this scale.

Fisher's exact test was implemented by the research team to compare attitudes toward individuals with HS versus atopic dermatitis and those with or without a history of either of these skin conditions. The team concluded that among 497 survey respondents, a total of 350 were able to correctly answer the inquiries in the screening process, leading to a 70% rate of response.

Study Results

In 1 notable conclusion, the research team found that there were more stigmatizing views expressed towards romantic relationships with individuals with atopic dermatitis versus HS (mean Likert score 3.49 compared to 3.68, P = .03), which was the only significant distinction in attitudes between both of the skin diseases.

The myth that those with these skin condition were to blame for their condition was endorsed by some respondents as well (64.3% compared to 64.6%, P = 1.0), with minimal difference in stigma toward HS versus those with atopic dermatitis. Discomfort with hiring individuals known to have atopic dermatitis or HS (18.3% compared to 17.4%, P = .8) were reported by the investigators, in addition to a view that patients with HS or atopic dermatitis had poor levels of hygiene (27.7% compared to 28.0%, P = .9).

Those without a history of atopic dermatitis and HS were reported to have shown more stigmatizing views compared to those with a history of these conditions (P < .0001).

Overall, a reduced quality of life due to stigma was observed among many of those with HS and atopic dermatitis. Limitations of the analysis were noted by the research team due to the self-reported outcomes gathered via MTurk, though future research related to biases against patients with these skin conditions may require pursuit.

“Our study is limited by self-reported outcomes recorded via MTurk crowdsourcing software,” they wrote. “Still, the findings set the foundation for future research on the negative biases towards patients with HS and (atopic dermatitis).”

References

1. ^{Greenzaid, J.D., Johnson, M.C. and Feldman, S.R. (2024), Evaluation of public perception towards patients with hidradenitis suppurativa and atopic dermatitis. JEADV Clin Pract. https://doi.org/10.1002/jvc2.489.}
2. ^{Schneider-Burrus S, Jost A, Peters EMJ, Witte-Haendel E, Sterry W, Sabat R. Association of hidradenitis suppurativa with body image. JAMA Dermatol. 2018; 154(4): 447–451.}
3. ^{Chernyshov P. Stigmatization and self-perception in children with atopic dermatitis. Clin Cosmet Investig Dermatol. 2016; 9: 159–166. https://doi.org/10.2147/CCID.S91263.}
4. ^{Koumaki D, Efthymiou O, Bozi E, Katoulis AC. Perspectives on perceived stigma and self-stigma in patients with hidradenitis suppurativa. Clin Cosmet Investig Dermatol. 2019; 12: 785–790. https://doi.org/10.2147/CCID.S180036.}