Patients often suffer with much more than the skin manifestation of atopic dermatitis (AD), or eczema. Children with AD who present to pediatricians also may be more likely to experience decreased self-esteem, anxiety, bullying, and more, says Sasha D. Jaquez, PhD, a pediatric psychologist at Dell Children’s Medical Center and assistant clinical professor of Psychiatry, Dell Medical School, University of Texas at Austin.
A tough road for kids with eczema
Researchers analyzing health status data from 92,649 noninstitutionalized children, aged 0 to 17 years, found a “striking association between mental health disorders and AD in the US pediatric population. The severity of the skin disease alters the strength of the association,” they wrote in a paper published in 2013 in the Journal of Allergy and Clinical Immunology.1
Researchers studying psychosocial problems in adolescents with eczema found that 15.5% of teenagers with current eczema reported suicidal ideation compared with 9.1% of those without eczema.2 Another finding from that study: Boys with current eczema were less likely to have had romantic relationships than those without, according to the study in the Journal of Investigative Dermatology.
In a study published in the Scandinavian Journal of Caring Sciences, researchers concluded that teasing, taunting, and bullying may represent an underappreciated source of psychologic morbidity in children and adolescents with eczema, acne, and psoriasis.3
Pediatric dermatologic disorders, including AD, impact self-esteem throughout childhood, according to a study published in the International Women’s Journal of Dermatology.4
“In addition to the surgical and medical management of these disorders, clinicians can also take an active role in the assessment and improvement of the psychosocial impact of these skin disorders,” those authors concluded.4
Pediatricians should be mindful that what they see with AD patients isn’t necessarily all that there is. They also should be cognizant about the risk for psychologic and social comorbidities, says Jaquez, who presented “Healing children one layer at a time: integration of Psychology in pediatric Dermatology,” in July during the Society for Pediatric Dermatology 44th Annual Meeting in Austin, Texas.
“The pediatrician or dermatologist who might be the first to identify the problems but doesn’t have time to focus on this during treatment should refer to a psychologist who is trained to focus on how to get the child to be [his/her] best self despite the medical condition that they have,” Jaquez says.
Pediatric psychologists, according to Jaquez, see more than traditional outpatient mental health concerns, such as depression and anxiety.
“What sets child/adolescent psychologists and pediatric psychologists apart is that knowledge of medical conditions and working on multidisciplinary teams to address difficulties a child and family experience related to the medical condition, whether it is a diagnosable psychiatric condition or not,” Jaquez says. “This would include seeing patients for nonadherence; coping with and acceptance of a medical condition; behavior problems in younger children, which may affect their adherence; sleep problems; and anxiety and depression related to the medical condition.”
1. Yaghmaie P, Koudelka CW, Simpson EL. Mental health comorbidity in patients with atopic dermatitis. J Allergy Clin Immunol. 2013;131(2):428-433.
2. Halvorsen JA, Lien L, Dalgard F, Bjertness E, Stern RS. Suicidal ideation, mental health problems, and social function in adolescents with eczema: a population-based study. J Invest Dermatol. 2014;134(7)1847-1854.
3. Magin P, Adams J, Heading G, Pond D, Smith W. Experiences of appearance‐related teasing and bullying in skin diseases and their psychological sequelae: results of a qualitative study. Scand J Caring Sci, 2008;22(3):430-436.
4. Vivar KL, Kruse L. The impact of pediatric skin disease on self-esteem. Int J Womens Dermatol. 2017;4(1):27-31.
5. Chernyshov PV. Stigmatization and self-perception in children with atopic dermatitis. Clin Cosmet Investig Dermatol. 2016;9:159-166.