{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:05:58Z","timestamp":1793142358891,"version":"4.5.0"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2024,6,1]]},"abstract":"\n Importance<\/jats:title>\n Chronic skin disorders in children frequently are visible and can cause stigmatization. However, the extent of stigmatization from chronic skin disease and association with mental health needs further study.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine the extent of stigma, dependence on disease visibility and severity, and association with mental health and quality of life (QOL) in chronic pediatric skin disease.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n A cross-sectional, single-visit study was conducted at 32 pediatric dermatology centers in the US and Canada from November 14, 2018, to November 17, 2021. Participants included patients aged 8 to 17 years with chronic skin disease and 1 parent.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Using the Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) Stigma-Skin, the extent of stigma with child-, caregiver-, and physician-assessed disease visibility (primary outcome) and severity was compared, as well as reduced QOL (assessed by Skindex-Teen), depression, anxiety, and poor peer relationships (PROMIS child and proxy tools) (secondary outcomes).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The study included 1671 children (57.9% female; mean [SD] age, 13.7 [2.7] years). A total of 56.4% participants had self-reported high disease visibility and 50.5% had moderate disease severity. Stigma scores significantly differed by level of physician-assessed and child\/proxy-assessed disease visibility and severity. Among children with chronic skin disorders, predominantly acne, atopic dermatitis, alopecia areata, and vitiligo, only 27.0% had T scores less than 40 (minimal or no stigma) and 43.8% had at least moderate stigma (T score \u226545) compared with children with a range of chronic diseases. Stigma scores correlated strongly with reduced QOL (Spearman \u03c1\u2009=\u20090.73), depression (\u03c1\u2009=\u20090.61), anxiety (\u03c1\u2009=\u20090.54), and poor peer relationships (\u03c1\u2009=\u2009\u22120.49). Overall, 29.4% of parents were aware of bullying of their child, which was strongly associated with stigma (Cohen\n d<\/jats:italic>\n \u2009=\u2009\u22120.79, with children who were not bullied experiencing lower levels of stigma). Girls reported more stigma than boys (Cohen\n d<\/jats:italic>\n \u2009=\u20090.26). Children with hyperhidrosis and hidradenitis suppurativa were most likely to have increased depression and anxiety.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n The findings of this study suggest that physician assessment of disease severity and visibility is insufficient to evaluate the disease impact in the patient\/caregiver. Identifying stigmatization, including bullying, and tracking improvement through medical and psychosocial interventions may be a key role for practitioners.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamadermatol.2024.0594","type":"journal-article","created":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T11:33:38Z","timestamp":1713958418000},"page":"621","source":"Crossref","is-referenced-by-count":80,"title":["Stigmatization and Mental Health Impact of Chronic Pediatric Skin Disorders"],"prefix":"10.1001","volume":"160","author":[{"given":"Amy S.","family":"Paller","sequence":"first","affiliation":[{"name":"Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois"},{"name":"Department of Pediatrics, Ann and Robert H. 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Washington School of Medicine, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lionel","family":"Bercovitch","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dermatology, Hasbro Children\u2019s Hospital, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah L.","family":"Stein","sequence":"additional","affiliation":[{"name":"Departments of Medicine\/Dermatology and Pediatrics, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Boull","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wynnis L.","family":"Tom","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dermatology, Rady\u2019s Children\u2019s Hospital, University of California, San 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