A new study published in Scientific Reports shows that patients with atopic dermatitis (AD) and psoriasis may suffer more from shame than from their physical symptoms. The research highlights that shame related to visible skin conditions can have a stronger impact on mental health and quality of life than depression or anxiety.
Shame More Harmful Than Symptoms?
Researchers surveyed 413 adults in German-speaking areas who had either AD or psoriasis. Participants answered questions about their feelings of shame, anxiety, depression, and overall quality of life. Tools used included the Skin Shame Scale (SSS-24), the Shame Assessment for Multifarious Expressions of Shame (SHAME), and mental health screeners like the PHQ-4.
The results showed no major difference between AD and psoriasis patients in terms of how much shame, anxiety, or depression they felt. But younger people and women reported more skin shame than older adults or men. Skin shame was more strongly linked to poor quality of life than any other factor—including depression or anxiety.
Disease Severity and Mental Health
Patients who believed their disease was severe also had higher levels of anxiety, depression, and shame. For AD patients, this link was clear regardless of how long they had the disease. In psoriasis patients, those with longer disease durations reported slightly less shame and anxiety, though this effect was not strong enough to draw firm conclusions.
Crucially, when researchers used regression models to look at what factors most influenced quality of life, two stood out: how bad the patients thought their skin disease was, and how ashamed they felt about their skin. Skin shame ranked higher than both anxiety and depression in affecting well-being.
Understanding Skin Shame
Shame is a deep emotion that makes people want to hide or disappear. It can stem from feeling unattractive or flawed. “Skin shame” is a type of body shame that affects people with visible skin problems, making them feel embarrassed or unworthy in social settings.
While skin shame is not often studied, this new research shows it could be just as damaging as other mental health issues. And unlike physical symptoms, it can be harder for doctors to see or measure.
Clinical Implications
The authors argue that doctors should pay more attention to shame in patients with AD and psoriasis. Adding questions about skin shame to routine assessments might help identify patients at risk for low quality of life. The study also suggests that treating shame through counseling or support groups could improve patients’ mental health and overall well-being.
“Assuming that skin shame is at least as relevant as depression and anxiety… addressing this painful emotion through screening and support may help improve quality of life,” the researchers concluded.
Final Thoughts
This study makes a strong case that emotional suffering, especially shame, deserves just as much attention as the physical symptoms of chronic skin diseases. As researchers continue to explore this topic, dermatologists and mental health professionals alike may need to work more closely to help patients truly heal—both inside and out.
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