A team of Scottish researchers surveyed 379 five to 16 year-olds, who had been suffering from skin diseases like acne, eczema and psoriasis for more than six months, together with their parents.
They asked the children and their parents how much the condition impaired the child's quality of life when it came to factors such as pain, loss of sleep, dietary restrictions, interference with school and play, friendships, teasing and bullying and medical treatment.
They then compared the quality of life scores given by the parents of 161 children with chronic diseases in the same age group.
Only six of the 546 parents approached by staff at Ninewells Hospital in Dundee and Perth Royal Infirmary preferred not to take part in the research. All the children included were attending outpatient clinics at the two hospitals.
Key findings included:
- The children in the study said that psoriasis (red scaly patches) and eczema were the two skin conditions that caused them the greatest distress. Both resulted in a 31 per cent impairment in their quality of life score. This was followed by urticaria (itchy allergic skin rash) at 20 per cent impairment and acne at 18 per cent impairment.
- From the parent's perspective, eczema was the biggest skin problem at 33 per cent, followed by urticaria at 28 per cent, psoriasis at 27 per cent and hair loss at 19 per cent.
- When they compared the overall results for the children with skin diseases and chronic illnesses, the researchers found that the condition that had the worst affect on quality of life was cerebral palsy at 38 per cent. Generalised eczema and kidney disease both scored 33 per cent.
- Cystic fibrosis also made the top five (32 per cent), followed by urticaria and asthma (28 per cent), psoriasis (27 per cent), epilepsy and bed wetting (24 per cent), diabetes, hair loss and localised eczema (19 per cent) and acne (16 per cent).
- When children with psoriasis, and their parents, were asked to chose the factors that affected the child's quality of life most, parents rated bullying third and children rated bullying fourth.
- Teasing or bullying was also a key concern for the 11 children with hair loss, with six of the children and nine of the parents putting it first on their list.
- The biggest concerns for children with eczema, psoriasis and uticaria was itching or pain, while children with acne or warts said that embarrassment was their main worry.
"Our study shows that children with chronic skin diseases – and their parents – reported the same level of quality of life impairment as the parents of children with many other chronic illnesses" says lead author Dr Paula Beattie from the Royal Hospital for Sick Children in Glasgow.
"Skin diseases are often more obvious to other children than chronic diseases such as asthma or diabetes and are more likely to lead to alienation, name calling, teasing and bullying.
"Some skin conditions can also disturb children's sleep and cause lack of self-confidence, embarrassment and poor self-esteem, especially as they get older.
"Although skin diseases may not shorten life in the same way as serious conditions like cystic fibrosis, they can cause children as much, if not more, distress in their everyday lives."
"Measuring quality of life can be a powerful political tool as it provides the patient's perspective on the health impact of different diseases" adds co-author Dr Sue Lewis-Jones from Ninewells Hospital, Dundee.
"This is particularly important when arguing for vital resources, especially in dermatology, as skin diseases are not considered to have as much of an impact on people's lives as other illnesses.
"Our study clearly shows the profound effect skin diseases can have on children's quality of life and we hope that our findings will raise awareness of the problems they face and encourage greater sensitivity towards them."
Journal
British Journal of Dermatology