Strategies to reduce stigma related to visible chronic skin diseases: a systematic review

Abstract

Many patients with a visible chronic skin disease experience discrimination and stigmatization. This results in psychosocial impairments in addition to the burden of disease and emphasizes the urgency to implement effective stigma‐reduction strategies. To synthesize what is known globally about effective interventions to reduce stigma associated with visible chronic skin diseases, a systematic review was conducted. Four electronic databases were searched until May 2018. Studies evaluating interventions to reduce stigmatization in patients with visible chronic skin diseases and applying at least one stigma‐related outcome measure were included. Data were extracted on study design, country, study population, outcome measures and main findings. Results were subsequently synthesized in a narrative review. Critical Appraisal Skills Programme tools were used to assess study quality. Nineteen studies were included in the review. Study design was very heterogeneous and study quality rather poor. Thirteen studies addresses patients with leprosy in low‐ and middle‐income countries, and one study each targeted patients with onychomycosis, leg ulcer, facial disfigurement, atopic dermatitis, vitiligo and alopecia. Evaluated interventions were mainly multi‐faceted incorporating more than one type of intervention. While 10 studies focused on the reduction in self‐stigma and 4 on the reduction in public stigma, another 5 studies aimed at reducing both. The present review revealed a lack of high‐quality studies on effective approaches to reduce stigmatization of patients with visible chronic skin diseases. Development and evaluation of intervention formats to adequately address stigma is essential to promote patients’ health and well‐being.

Stigmatization and Quality of Life in Patients with Psoriasis

“…The scale for questions no. 9,11,12,16,17,20,23,25, and 33 is inverted, so regardless of the question, higher score corresponds to higher stigmatization level. The questionnaire is used to determine the level of disease-related stigmatization in six domains: (1) anticipation of rejection, (2) feeling of being flawed, (3) sensitivity to the opinions of others, (4) guilt and shame, (5) positive attitudes, and (6) secretiveness.…”

“…There are two types of stigma, social stigma and selfstigma. The social stigma occurs whenever members of society reject or exclude the individuals who are different from others, treating them in an unfair and discriminative manner [8,9]. The self-stigma happens if a person presents with low self-esteem and the feelings of shame and hopelessness because of an illness [10].…”

“…While social stigmatization and self-stigmatization may occur independently of each other, they may also co-exist [9].…”

“…Previous studies did not identify the interventions that would effectively attenuate the sense of stigmatization. Furthermore, it should be remembered that the interventions developed in one country may not necessarily be effective in another as a result of the overlapping effect of cultural and socioeconomic factors [9].…”

“…The sense of stigmatization can be diminished not only through psychological interventions aimed at intrapersonal activities but also through interpersonal activities, such as [9,[21][22][23][24]:…”