Skin conditions can be associated with heightened levels of psychological morbidity, suggesting the need for psychological interventions. A number of specific interventions (such as habit reversal) have been developed. However, to date, there has not been a systematic review of the effectiveness of psychological interventions. We sought to systematically evaluate the effectiveness of psychological interventions designed to improve the severity of and adjustment to skin conditions in adults. Database, archival and citation searches were conducted. Studies were included if participants were allocated to either a psychological intervention (excluding educational interventions and complementary therapies) or a comparison condition, and if they measured outcomes relevant to the skin condition. Twenty-two studies met these inclusion criteria. Effect sizes for each intervention were computed and we also coded a number of potential moderators of intervention efficacy. Psychological interventions were found to have a medium-sized effect on skin conditions (g = 0·54). The type of skin condition, age of sample, nature of the intervention, time interval between the end of the intervention and follow-up, and type of outcome measure all moderated the effect of interventions on outcomes. For example, interventions had a medium effect on the severity of the condition (g = 0·40) and psychosocial outcomes (g = 0·53), and a medium-to-large effect on itch/scratch reactions (g = 0·67). Psychological interventions are beneficial for people with skin conditions. However, more research is needed to extend the variety and focus of the psychological interventions that are available. Studies are also needed to explore the longer-term benefits of such interventions.

SummaryBackground While rosacea is a chronic skin condition, it can often have a large psychosocial impact on the individual. There is therefore a need to understand the experience of living with rosacea from the patient perspective. Objectives To examine the experience of living with rosacea and the experience of seeking and receiving treatment. Methods Nine participants took part in semistructured interviews, which were analysed using interpretative phenomenological analysis. Results Three superordinate themes were identified within the data: 'self-consciousness', which focused on the fear of others assigning blame to participants for having caused symptoms; 'avoidance, concealment and hiding emotions', referring to the coping strategies participants employed in response to rosacea; and 'inconsistencies in general practitioner treatment and guidance', which focused on the need for medical professionals to assess the psychosocial wellbeing of patients with rosacea. Conclusions Rosacea can have a negative impact on the daily life of people with the condition, contributing to lowered self-esteem, embarrassment and feelings of shame. Engaging in emotion-focused and behavioural/avoidant-focused coping strategies increased participants' confidence and reduced their avoidance of social situations. However, such strategies might still serve to maintain underlying unhelpful cognitive processes. Consequently, it is important for medical professionals to assess for the presence of cognitive factors that might contribute to maintaining distress in patients with rosacea, and where unhelpful thoughts or beliefs are reported, patients may need to be referred for psychological support.

Summary Background Individuals with visible skin conditions often experience stigmatization and discrimination. This may trigger maladaptive responses such as feelings of anger and hostility, with negative consequences to social interactions and relationships. Objective To identify psychosocial factors contributing to aggression levels in dermatology patients. Methods Data were obtained from 91 participants recruited from outpatient clinics in the north of England, U.K. This study used dermatology‐specific data extracted from a large U.K. database of medical conditions collected by The Appearance Research Collaboration. This study looked at the impact of optimism, perceptions of social support and social acceptance, fear of negative evaluation, appearance concern, appearance discrepancy, social comparison and well‐being on aggression levels in a sample of dermatology patients. Results In order to assess the relationship between variables, a hierarchical regression analysis was performed. Dispositional style (optimism) was shown to have a strong negative relationship with aggression (β = −0·37, t = −2·97, P = 0·004). Higher levels of perceived social support were significantly associated with lower levels of aggression (β = −0·26, t = −2·26, P = 0·02). Anxiety was also found to have a significant positive relationship with aggression (β = 0·36, t = 2·56, P = 0·01). Conclusions This study provides evidence for the importance of perceived social support and optimism in psychological adjustment to skin conditions. Psychosocial interventions provided to dermatology patients might need to address aggression levels and seek to enhance social support and the ability to be optimistic.

Insecure attachment orientation (high attachment avoidance or high attachment anxiety) is linked to poorer adjustment. People with insecure attachment might benefit from psychological interventions that target underlying attachment orientation.

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