Common misconceptions about skin disease

Because most skin conditions are not life-threatening, they do not pose a big problem for the patient. If the condition is not physically handicapping, then the person's activities and daily routine can't be affected. The consequences that a skin disease has on the sufferer's life must be directly related to how severe the condition is. Everyone with a skin condition is affected in the same way, regardless of sex, age or race. There is no difference in how people react to different skin...

Explaining skin disease to children

Samantha was a happy, outgoing 6-year-old who had been born with a large port-wine stain on the left side of her face and neck. The mark did not seem to bother Samantha. She and her mother referred to it as her 'strawberry stamp', and joked about how it was proof that she loved strawberry ice-cream. When she was around other children, they would ask her questions about it and she seemed comfortable talking about it and consequently did not appear to have difficulties engaging with other...

Psychologists

Psychologists are non-medical professionals who are trained to help people to deal with emotional and behavioural problems. The training they receive is based on a past knowledge of psychological theory and often includes specialised clinical training, although not always. Psychologists often work with individuals or families and, in the case of skin disease, they have been shown to have achieved considerable success with both adult and child skin disease patients. Since skin disease can often...

What to do when people ask

If someone asks you about your skin condition, the first thing to decide is whether you want to answer the question. Remember that you have the right to keep your condition private, even though others may be able to see it. If you do decide to discuss your condition, take on the role of 'educator'. You can explain the cause of your condition, how common it is and how it affects you. Doing this with confidence may provoke a more positive reaction from the enquirer.

Other media

Women's magazines have always tried to emphasise faults in appearance and to highlight the importance of looking like the glossy images which adorn their covers and articles. Magazines show images of women with perfect skin and hair, perfect teeth, and perfect breasts and legs, and often serve to create a kind of stereotype which women feel they have to look like. It is often the case that any deviation from these magazine stereotypes can make many of the readers feel 'abnormal' and different....

How do I explain my childs condition to them

Depending on the child's age, they will have a different ability to understand abstract concepts. Up to age 11, children are very concrete. So, even abstract things like 'forever' and 'never' are very difficult to grasp. 'I've been waiting for this Barbie doll forever,' seems like a reasonable thing if Christmas is far away. So knowing that they're going to live with a condition forever doesn't necessarily mean that they understand what that means. When we explain to kids, we need to explain in...

Skin disease and the parentchild relationship

The relationship between the child and the parent may have implications for the way in which the child makes sense of and copes with his or her condition. Research suggests that one of the most significant factors in the development of behavioural problems of children with disfiguring skin conditions is the reaction of the parents to the illness or deformity. Over-protective parents who shield their child from social problems, such as teasing, may prevent the development of childhood...

Coping with teasing

Apart from the child's family, the school is likely to be the next most important environment affecting a child's adjustment. Children who are obviously visibly different to their peers may attract negative attention, leading to teasing and bullying. This sort of treatment may in turn affect the social and interpersonal skills that the child develops, and in some cases can even interfere with learning. Although some children are able to confide in their parents about experiences of having been...

How can the media benefit those with a lessthanperfect appearance

It is, perhaps, not as important to educate the general public about the truths and the myths about skin disease passed from generation to generation as it is to tackle the characterisation of characters in the media that we discussed above. Recent examples with legislation against racial bias on television and radio have had far-reaching and successful benefits for that cause. Although gaining legislation for facial prejudice is less likely, it is still something that can be pushed for....

Visibility and choice about whether or not to discuss the condition

Since many dermatological conditions are immediately visible to others, patients may have no choice as to whether or not they wish to disclose the fact that they have a skin condition to those around them. Other illnesses, which are less prominent, can remain private and personal matters until the patient chooses to disclose details about them. The dermatology patient may feel that this choice has been taken away from them and may resent the fact that their condition is visible to others....

How do I find a therapist or counsellor to talk to

This is a hard one - most of us don't know what therapy actually is, let alone how to go about finding it, or knowing what a good therapist is. A good rule of thumb is to make sure that the practice is regulated by a governing body. In the UK there are the British Psychological Society, the British Association of Counsellors and the United Kingdom Chartered Psychotherapists. They will have a list of psychology services in your area. They should also let you know where their interests lie. For...

Acne

Definition - a chronic inflammation of the pilosebaceous glands (hair follicles that contain large oil-producing cells) of the face, upper arms and upper chest. Lesions over the follicles, which become blocked by oil, may appear as solid elevations of the skin (papules), as pus-filled blisters (pustules), as cysts or as scars. Clinical variants of the condition include - acne conglobata this is the most severe form in which large nodules and cysts rupture under the skin leaving scars - acne...

How is skin disease different from other conditions

Over our years of experience in counselling patients in medical settings it has always struck us how illnesses (and consequently their impact) are assessed in terms of their severity. The assumption is made that the more severe a condition is, the more severe the psychological impact will be on the patient. As a consequence, skin diseases that are rarely life-threatening or physically handicapping, are thought not to pose much of a problem for those that experience them. The fact of the matter...

Coping with the disfiguring effects of skin disease

Some patients complain that health care professionals are sometimes unhelpful or dismissive. They are told, 'It's only a cosmetic disorder', or, 'it has no debilitating effects'. Unfortunately these utterances capture neither the severity nor the complexity of the sufferer's experience. More importantly, they minimise the distress and feelings of self-consciousness experienced by many patients. The disfiguring nature of certain skin conditions suggests that patients not only have to contend...

Feel that Ive been discriminated against in the workplace What can I do about that

The Anti-Discrimination Act 1999 makes it an offence to discriminate against people on the grounds of facial or any other sort of visible disfigurement. So, make sure you know your rights - that's the first thing. Be clear about why discrimination is happening. Know who to call on in terms of human resources. And, dealing with the emotional aspect of it, it's about them and not about you. Ask yourself if it's a job you want to be working in. If it is, then there are steps you can take....

Contents

2 Myths about skin disease, the media and stigma 5 3 Facts about skin disease causes and prevalence 19 5 The impact of skin disease on relationships 35 7 Treatment 1 The people (health professionals, skin camouflage and support groups) 55 8 Treatment 2 Psychology and skin disease 63 References and suggested further reading 91 Index 93

About the authors

DR LINDA PAPADOPOULOS is a Reader in Psychology at London Metropolitan University with specific research interests in the field of psychodermatology, and she has consistently published in this field. Dr Papadopoulos is a chartered health and counselling psychologist who has worked in primary care settings as well as maintaining her research group. She also has extensive media commitments, appearing regularly on television and writing her monthly column in Cosmopolitan magazine. CARL WALKER is a...

How can I help my child to cope

Parents often say, 'I wish it was me and not my child,' and that's understandable. We hope that everything in their life goes perfectly and wonderfully, so when they come home from school for the first time crying, because little Johnny pulled their pigtails or whatever, it's distressing. As in the case of adults, helping them cope is a lot about giving them a toolbox of social skills and self-esteem skills that can help them. So, as discussed earlier, things...

How do I tell someone what the disease is

That's the funny thing about skin disease. Sometimes people feel that they have the right to know what something is just because they can see it. Once again, like staring, you can make that decision. You decide whether you feel you need to address the situation. It's not your responsibility to allay people's fears or concerns. So, the first thing I always tell my clients is that it is a private and personal disease. If you feel that you want to let someone know what it is, then that is...

Myths about acne

Acne is related to diet - no evidence exists to suggest that any particular foods directly cause acne. Acne results from a person's inability to 'properly take care of themselves' - acne is actually due to inherited factors that increase the production of a substance called sebum and has nothing to do with how a person 'takes care of themselves'. Strong cleansers and constant scrubbing are helpful - this can actually lead to increased inflammation mild non-abrasive cleansing is best. Acne is...

Nurses

Almost everyone is aware of the role of nurses in looking after the needs of patients in hospital. Nurses are often involved with the consultation and treatment aspects of skin disease. There are other ways that nurses can be involved in the care of those with skin diseases. Nurses often have daily contact with patients and their families during hospital treatment and so may be the first professional to be aware of the distress involved with the condition. They have experience of...

Stress and emotions

Stress has been shown to be an important contributory factor in conditions such as eczema and psoriasis. The way in which stress affects these conditions is thought to be a complex process which involves changes in the way children perceive their pain and itching, changes in the child's immune function and changes in inflammatory responses. Research on children with skin diseases has focused on the role of the family environment in the maintenance of the symptoms. Different kinds of stress and...

Portwine stains naevus flammeus

Definition and distribution - this is a congenital condition which presents as a flat, irregular, red or purple lesion. There are two types of port-wine stains - medially located naevi, occurring as faint red lesions over the scalp, nape of neck or centre of face these tend to remain flat throughout the patient's life and become less prominent over time - laterally located naevi on the other hand are usually seen unilaterally over the face but may also occur on the extremities these begin as...

Television

There has been much research into how television can portray people who look different from the 'normal' and, although only some of the research directly concerns skin disease, much of it addresses facial differences, body differences and disability. But it is important to look at the work in all these areas to understand how television operates overall with respect to those who look different the 'big picture', if you like. Here are the results of some interesting research Donaldson (1981)...

What is counselling

The term counselling is often used to describe various different interactions between people, so we need to clarify what we mean when we use the term. In our definition counselling is understood as An interaction in a therapeutic setting, focusing primarily on a conversation about relationships, beliefs and behaviour (including feelings), through which the patient's perceived problem is elucidated and framed or reframed in a fitting or useful way, in which new solutions are generated and the...

Malignant melanoma

Definition and distribution - malignant melanoma is a tumour of the melanocytes or tanning cells, resulting from the malignant transformation of these epidermal cells it is the most lethal type of skin tumour. There are four main variants of this condition superficial spreading malignant melanoma, being the most common type accounting for 50 per cent of all cases seen in the UK. A higher proportion of females than males is affected and the condition is most commonly seen on the lower leg....

Eczema

Definition - eczema is an inflammation of the skin frequently seen in association with the allergic conditions, asthma and hay fever. It is characterised by moist red weeping skin during the acute stages and dry, scaly skin in its more chronic forms. Distribution - most commonly affects the face and the knees and elbows Prevalence - approximately 12-15 per cent of infants are affected by the so-called atopic (a hereditary tendency to react to certain allergies) forms of this condition. It...

Excerpt from a counselling session with Marissa a skin cancer patient

My husband and I have been married for 30 years. He is a good man and we've always had a good marriage. But since the cancer I've been feeling that that maybe he thinks I am ugly. Like the other night, I well I felt like kissing him. When he said he was tired, all I heard was, 'you are ugly, go away'. And it's hard to get those ideas out of my mind, I mean but for a bigger belly and less hair, he doesn't look very different to the day I married him, but me . well, I am a different person. When...

Vitiligo

Definition - vitiligo is an acquired disorder resulting in the occurrence of white non-scaly lesions. At the affected sites, the hair also usually loses its colour. The course of the condition is unpredictable, some areas perhaps remaining unaffected for years, others completely losing their pigmentation within a few weeks. Distribution - loss of pigmentation can occur anywhere on the body's surface but commonly on knees, elbows, hips, nipples, genital area, hands and feet. The condition can...

Dermatologists

These are physicians who specialise in dealing with skin conditions which require medical treatment. The conditions that dermatologists work with include acne, psoriasis, eczema, vitiligo, urticaria and some skin cancers. They often prescribe conventional medical treatments such as steroid creams, tablets, lotions and sessions of ultraviolet light therapy and can give good advice to patients and parents of children with skin conditions on good management of the skin. Since they tend to...

Myths about skin disease the media and stigma

This chapterwiU outline the common myths about skin disease and the ways in which the media can affect these. We will then look at the ways in which people can feel stigmatised as a result of these myths. Unlike conditions such as cancer and HIV, which are ranked high on the list of medical problems in terms of public awareness, dermatological conditions rarely receive attention in public health campaigns and so their effect on people's lives tends to be underrated. Furthermore, this lack of...

How can I be assertive with my doctor if I feel that Im not getting the treatment that I require

One of the things that dermatological patients complain about more than anything is that they don't feel listened to by their GPs, and, indeed, that they don't receive the right referrals. Not surprisingly, this is not the case just with dermatological patients but with a lot of people attending general practices. Doctors are busy and long waiting lists mean that the quicker the type of treatment, the better. Because skin diseases aren't life-threatening and aren't seen as something that should...

Where do many of these beliefs come from the role of the media

One of the main ways that people can understand the problems facing those with skin diseases involves knowing how the media, such as television and magazines, can work to belittle or harm people with skin disease and how negative ideas are spread and transmitted. In this section we will cover the ways in which the media transmit messages concerning physical beauty, perfection and disfigurement, and will offer suggestions and practical advice as to how the influence of these aspects can be...

Structuring life around disease when it gets better I will

One of the most common 'coping mechanisms' displayed by people with skin problems is a desire to treat and get rid of the condition rather than getting on with living with it. Behaviours such as taking up new sports, applying for a promotion or even getting married are postponed in the hope that the condition will be cured, enabling them to lead more enjoyable lives. Here follows a section taken from a counselling session with a 22-year-old Asian woman who had recently been diagnosed with...

Coping

'Coping' is an active process, which relies on a range of techniques used at different times. These vary from seeking social support to venting emotions and confronting risk. In a recent review by Moss and Savin (1995), the coping strategies of people with some form of disfigurement were examined. The authors found that the concept of coping was divided into the broad categories of emotion-focused coping and problem-focused coping. The former deals with the way people attend to threat. That is,...

How do I know which herbal cures are actually useful

There has been a lot of controversy in recent years over herbal cures and medical conditions as a whole. The main reason for this is because there are a lot of charlatans out there, people who promise miracle cures but don't deliver anything of substance. It's therefore very important in the case of doctors or psychologists that you know these people are registered. There are societies that exist that can tell you whether these people are registered practitioners of medicine and pharmacology....

What if people stare

They may be curious they may be unsettled or they may be being intentionally rude. It is rarely possible to tell which it is. Handle staring by making eye contact with the person and smiling. You will send the message that you are aware of the staring but that you are OK with the way you look and who you are. The eye contact is usually enough to make the person avert their gaze. The smile tells them that you are confident, rather than annoyed, and that you are...

Facts about skin disease causes and prevalence

As is case with most illnesses, the manner in which a skin disease is acquired, and the course it will run, can significantly affect the way a person adjusts to their condition. In Chapter 2 we discussed many of the mythical lay beliefs on skin disease. In this chapter we look at the facts about skin disease, focusing on the definition, causes, prevalence and treatment of well-known conditions as well as giving a general overview of some of the terminology used to describe skin disease...

Reactions of strangers

I was at the cosmetics counter in a large department store when I noticed two teenage girls looking at me and laughing. They were being really rude and although I don't usually say anything I mean I don't usually react to rude remarks, I asked them what their problem was. One of them then looked at me in disgust and said, 'We don't have a problem but you do because no matter how much make-up you buy you are still going to look like a freak'. I was so shocked and distressed by what they had...

When patients get it wrong

Through their attitudes and behaviour, patients too can contribute to poor doctor-patient relations. Patients often bring a sense of anxiety into the consultation room and this can lead to the patient experiencing difficulties in attention and concentration making it difficult for the patient to process incoming information. This kind of anxiety can also make it difficult to retain what information is learned. Another problem that the patient can bring is the fact that they often 'respond to...

Support groups

There are many support groups, which are organised by people with different types of disfigurements and their families. These groups fulfil several purposes, ranging from offering mutual support to campaigning for political change. Some groups are highly structured and run by committees who organise such activities as public campaigns, fund-raising and social activities. Some groups are more geared toward offering individuals the opportunity to get in contact with other people. These support...

Transcript of Sandras experience an eczema patient

I met this really cute guy at a club over Christmas and he asked for my phone number. We went out on a few dates together and things were really going well. I was very confident and didn't even think about my eczema until he asked me to spend the weekend with him. I knew we would end up sleeping together and I knew there was no way I could hide the patches. I was convinced that if he saw the way I looked that he would never want to be with me again. So I told him I couldn't go, I made up a dumb...

When do I tell them

The location of the skin problem may mean that it is not immediately visible and so the decision as to whether and when the person will tell others can be delayed. If, for example, the condition affects the chest or the back, then these may not be visible while the person is clothed. Problems may first arise in situations where the person has to remove their clothing, i.e. when changing clothes, having sexual relations or at a public swimming pool. It is important that the patient decides at...

How do I feel less selfconscious in general

It certainly can be done but it requires a restructuring of how we think about the condition in general. Unfortunately, most of us, especially in Western society, feel self-conscious when anything remotely deviates from the airbrushed 14-year-old bodies we see in popular magazines. How much more this is so when it is a skin condition that is visible to other people But we need to remember that there is more to us than skin or than physical beauty. We have to stop seeing our...

The media friend or enemy

Since mass media began, it has had a very strong effect on society and certain standards in society but the type of information supplied has gradually changed over the years. The media have moved from a point where they were expected to be mirrors of news and to simply report everyday events, that is reporting mainly facts and figures with little opinion. Over the years, in-depth reporting has become more and more popular, with reporters giving explanations and opinions for the events they...

Cosmetic camouflage

The British Red Cross Society Skin Camouflage Service, run by the British Red Cross, provides a nationwide service offering advice to individuals on the selection and application of camouflage creams. The creams can be used on all areas of the body to reduce the impact of a variety of conditions and scarring. They are useful for covering vitiligo and are particularly effective when used on the face. Camouflage creams differ from ordinary cosmetics in that they have a greater opacity, therefore...

Mourning for a sense of normality a case of psoriasis

I used to love to swim, it was something that I took up about 5 years ago and was practically addicted to it ever since. At first when I noticed the psoriasis around my knees it didn't bother me, but since then I have begun to feel like people are avoiding me, like they look at me and know I'm different. I don't feel normal anymore, I feel that people are looking at me and wondering what happened or thinking, 'Oh he must be so brave to be able to swim looking like that'. Consequently, I have...

Challenging thinking errors

After you have learned to identify negative thoughts you will need to learn to change. If you are working with a therapist you will find that he or she uses questions to help you to challenge your beliefs. She will encourage you to think through alternatives to your beliefs or responses rather than holding on to your negative thoughts. For example, a therapist might ask a patient who is worried about other people noticing her eczema Counsellor What is the worst thing that you could imagine if...

The impact of skin disease on relationships

Effect Skin Disease

Previous chapters have described the emotional and psychological effects of skin disease on the individual. However, as is the case with most illnesses, skin disease has an impact on a person's relationships, which inevitably affects, and is affected by, the individual's condition. In this chapter we consider the impact that skin conditions have on different relationships and consider some of the social situations in which difficulties regarding the skin condition may arise. Furthermore, the...

Counselling and dermatology

Psychological treatment for people affected by a skin disease have ranged from psychoanalysis to the use of hypnosis, and treatment methods have been reviewed for a number of skin diseases such as acne, psoriasis, eczema and virus-mediated diseases. The published literature in this field suggests that psychological interventions have proved to be effective for many different disorders. Psychological interventions, such as suggestion and hypnosis, have been shown to have the capacity to enhance...

Linda Papadopoulos And Carl Walker

Many health problems and worries are strongly influenced by our thoughts and feelings. These exciting new books, written by experts in the psychology of health, are essential reading for sufferers, their families and friends. Each book presents objective, easily understood information and advice about what the problem is, the treatments available and, most importantly, how your state of mind can help or hinder the way you cope. You will discover how to have a positive, hopeful outlook, which...

Myths about malignant melanoma skin cancer

This only affects people who live in very hot climates - this is not true. The harmful rays from the sun may be more dangerous to sun-worshippers from cool climates who then expose their skin to sun intensively over short periods, rather than those who expose themselves steadily and moderately throughout the year. If I am naturally dark-skinned then I am not likely to get a melanoma and don't need protection from the sun - although people with darker skins are less likely to become...