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Observational Study
. 2023 Jun 22:103:adv6485.
doi: 10.2340/actadv.v103.6485.

Perceived Stigmatization among Dermatological Outpatients Compared with Controls: An Observational Multicentre Study in 17 European Countries

Sylvia Van Beugen  1 , Christina Schut  2 , Jörg Kupfer  2 , Antony P Bewley  3 , Andrew Y Finlay  4 , Uwe Gieler  5 , Andrew R Thompson  6 , Tamara Gracia-Cazaña  7 , Flora Balieva  8 , Bárbara R Ferreira  9 , Gregor B Jemec  10 , Lars Lien  11 , Laurent Misery  12 , Servando E Marron  13 , Sonja Ständer  14 , Claudia Zeidler  14 , Csanád Szabó  15 , Jacek C Szepietowski  16 , Adam Reich  17 , Amna Elyas  18 , Ilknur K Altunay  19 , Franz J Legat  20 , Vesna Grivcheva-Panovska  21 , Dmitry V Romanov  22 , Andrey N Lvov  23 , Géraldine Titeca  24 , Francesca Sampogna  25 , Nienke C Vulink  26 , Lucia Tomás-Aragones  27 , Andrea W M Evers  28 , Florence J Dalgard  18 ; European Society for Dermatology and Psychiatry (ESDaP) Study collaborators
Collaborators, Affiliations
Observational Study

Perceived Stigmatization among Dermatological Outpatients Compared with Controls: An Observational Multicentre Study in 17 European Countries

Sylvia Van Beugen et al. Acta Derm Venereol. .

Abstract

Perceived stigmatization places a large psychosocial burden on patients with some skin conditions. Little is known about the experience of stigmatization across a wide range of skin diseases. This observational cross-sectional study aimed to quantify perceived stigmatization and identify its predictors among patients with a broad spectrum of skin diseases across 17 European countries. Self-report questionnaires assessing perceived stigmatization and its potential predictors were completed by 5,487 dermatology outpatients and 2,808 skin-healthy controls. Dermatological diagnosis, severity, and comorbidity were clinician-assessed. Patients experienced higher levels of perceived stigmatization than controls (p < 0.001, d = 0.26); patients with psoriasis, atopic dermatitis, alopecia, and bullous disorders were particularly affected. Multivariate regression analyses showed that perceived stigmatization was related to sociodemographic (lower age, male sex, being single), general health-related (higher body mass index, lower overall health), disease-related (higher clinician-assessed disease severity, presence of itch, longer disease duration), and psychological (greater distress, presence of suicidal ideation, greater body dysmorphic concerns, lower appearance satisfaction) variables. To conclude, perceived stigmatization is common in patients with skin diseases. Factors have been identified that will help clinicians and policymakers to target vulnerable patient groups, offer adequate patient management, and to ultimately develop evidence-based interventions.

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Conflict of interest statement

SvB received lecture fees from Abbvie and Almirall, and research funding from NWO. APB received ad hoc consultancy/travel/lecturing fees from Abbvie, Almirall, Eli Lilly, Galderma, Leo Pharma, Janssen, Novartis, Sanofi, and UCB. AWME received funding from the following agencies: ERC, NWO, Dutch Health Associations (e.g. Diabetesfonds, ReumalandNL, Nierstichting), L’Oreal, and Province South Holland. UG received support and lecture honorarium in clinical and scientific meetings from AbbVie, Eli Lilly, Galderma, Janssen-Cilag, Leo Pharma, Pfizer, Sanofi-Aventis and UCB. He is principal investigator in acne studies about stigmatization and scars in acne patients, Co-Investor in Stigmatization in Rosacea-patients with Galderma, and Principal Investigator in Habit-Reversal Techniques in atopic dermatitis patients with Beiersdorf and Co-Investor in a communication and psychosocial comorbidities study in psoriasis patients with Novartis. FJL received support for participation in clinical and scientific meetings from AbbVie, Celgene, Eli Lilly, Galderma, Jansen-Cilag, Leo Pharma, Novartis, Pelpharma, and Pfizer. He has received Honoraria as Scientific Board Member/Consultant/Speaker from Almirall, Celgene, Eli Lilly, Galderma, Menlo Therapeutics, Novartis, Pelpharma, Pfizer, Trevi Therapeutics, and Vifor Pharma. He is Principal investigator in clinical studies for the following sponsors: Almirall, DS Biopharma, Eli Lilly, Galderma, Kiniksa, Menlo Therapeutics, Leo Pharma, Pfizer, and Trevi Therapeutics. BRF received fees from a lecture organized by Novartis and for participation in advisory board from La Roche-Posay. AYF is joint copyright owner of various quality of life measures. Cardiff University receives royalties: AYF receives a share under standard university policy. Lecture honoraria from Eli Lilly and WebinarMD. MG has participated in advisory boards and/or received fees from lectures from Abbvie, Leo, Lilly, Novartis, Pfizer, Sanofi, and Takeda. LM has received research grants from: Beiersdorf, Clarins, Expanscience, Galderma, Gilbert, Lilly, and Naos. He has received honoraria as an investigator from: Abbvie, Amgen, Biogen, Galderma, GSK, Janssen, Kiniksa, Lilly, Menlo, Novartis, Pfizer, Sanofi, and Trevi. He has done consultancy and/or has been in advisory boards for: Abbvie, Almirall, Amgen, Beiersdorf, Celgene, Clexio, Janssen, Lilly, Galderma, Kiniksa, Leo Pharma, Maruho, Menlo, Novartis, Pfizer, Sanofi, Sienna, Trevi, and Vifor. He has received speaker fees from: Abbvie, Almirall, Amgen, Biogen, BMS, Janssen, Lilly, Sanofi, Galderma, L’Oréal, Menlo, Beiersdorf, Leo Pharma, Novartis, Pfizer, and Vifor. AR has been a consultant or speaker for AbbVie, Bioderma, Celgene, Chema Elektromet, Eli Lilly, Galderma, Janssen, Leo Pharma, Medac, Menlo Therapeutics, Novartis, Pierre-Fabre, Sandoz and Trevi; and principal investigator or subinvestigator in clinical trials sponsored by AbbVie, Drug Delivery Solutions Ltd, Galderma, Genentech, Janssen, Kymab Ltd, Leo Pharma, Menlo Therapeutics, MetrioPharm, MSD, Novartis, Pfizer and Trevi. SS has received research grants from: Almirall, Beiersdorf, German Research Foundation (DFG), European Academy of Dermatology and Venereology (EADV), German Federal Ministry of Education and Research (BMBF), Interdisciplinary Center for Clinical Research Münster (IZKF), Leo Pharma, Menlo, Novartis, Sanofi, and Trevi Therapeutics. She has received honoraria as an investigator from: Clexio, Dermasence, Galderma, GSK, Kiniksa, Menlo, Novartis, Sanofi, Trevi, and Vanda. She has done consultancy and/or has been in advisory boards for: Abbvie, Almirall, Beiersdorf, Bellus Health, Benevolent, Bionorica, Cara, Celgene, CelloHealth, Clexio, DS Biopharma, Eli Lilly, Escient, Galderma, Grünenthal, Kiniksa, Klinge Pharma, Leo Pharma, Maruho, Menlo, Merz, P.G. Unna Academy, Perrigo, Pfizer, Sanofi, Sienna, Symbio Research, Trevi, Vanda, Vifor, WebMD. She has received speaker fees from: Almirall, BMS, Eli Lilly, Sanofi, Galderma, L’Oréal, Menlo, Omnicuris, Beiersdorf, Leo Pharma, Novartis, P. G. Unna Academy, Pfizer, Pierre Fabre, Universitätsklinikum Würzburg, and Vifor. CS has received lecture fees from Novartis, is a consultant for Mahana Therapeutics, US, and has received research funding from the University Clinic Marburg and Gießen (UKGM). JCS has been in Advisory Boards for, and/or has received honoraria for consultations from: AbbVie, Leo Pharma, Novartis, Sandoz, Sanofi-Genzyme, Trevi, UCB, and Vifor. He has received speaker fees from: Abbvie, Janssen-Cilag, Eli-Lilly, Novartis, Sanofi-Genzyme. and UCB. He has received honoraria as an investigator from: AbbVie, Amgen, BMS, Galderma, Galapagos, Incyte, InfraRX, Janssen-Cilag, Menlo Therapeutics, Merck, Novartis, Pfizer, Regeneron, UCB, and Trevi. ART is a scientific advisor to a number of dermatology charities including the vitiligo society in US. He is a trustee for the charity Changing Faces and a psychological advisor to the All Party Parliamentary Group on Skin and The Scar Free Foundation in US. He has received honorarium and research related funding from UCB, Pfizer, Novartis, and Sanofi. He has received research grant funding from The British Skin Foundation, and The National Institute for Health Research. GT has received payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Abbvie, Janssen, Leo Pharma, Novartis, and Almirall. She has received support for attending meetings and/or travel from Abbvie, Leo Pharma, Eli Lilly, Sanofi, Almirall, and Amgen. AE has received lecture fees from Perrigo and Beiersdorf, and lecture and travel fees from LEO Pharma. IKA, FB, FD, JK, LL, ANL, SEM, DVR, LT-A, NV, CZ have no conflicts of interest to declare.

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