The mental health of kids with AD has been found to be more severely affected than children living with diabetes, and the stigma and embarrassment of having a visible skin condition negatively impacts a child’s sense of identity and their self-esteem, which can lead to psychological problems in adulthood.1
Researchers have also found that parents of kids with AD may be less likely to discipline their affected child. Parents may be more likely to give in to the child’s demands because they see the negative impact AD has on them, but studies have found that poor discipline of children with AD results in a lack of opportunity to develop proper coping skills, which continues to affect the child into adulthood.1
Assessing a child’s body image
A simple way for dermatologists to assess a patient’s cutaneous (skin) body image is to ask “How satisfied are you with the appearance of your skin on a scale of 1 to 10, with 10 meaning ‘a lot’ and 1 meaning ‘not at all’?” Parents and caregivers can also use this question to understand their child’s mental perception. Asking the question not only provides insight into the psychological effects of living with AD, it validates the child’s concerns.
Minimizing the negative effect of atopic dermatitis on self-esteem
Once the effect of AD on self-esteem and a child’s sense of identity have been identified, coping strategies should be used to minimize the negative impact of AD, including:
“I’m more than my diagnosis:” Encouraging the child to separate his or her identity from their skin disease – helping the child to see that who they are is more than just the fact that they have this disease can help foster positive self-esteem.
Teasing and bullying: Teaching children how to handle teasing or other negative peer interactions – providing suggestions and role-playing can be helpful to children who experience teasing or bullying due to their AD.
Encouraging passions or hobbies: Shifting the focus from the skin to a passion will help to encourage children with AD to focus their attention on a hobby or passion that provides them with an innate sense of joy. A passion can also help the child connect with other kids who share the same interest.
Joining in group activities: Summer camps, support groups, and patient advocacy group memberships have all been shown to increase knowledge and coping skills among kids with AD, as well as helping kids realize they are not alone.
Finding a sense of control: Children with AD and their families do better when they feel a sense of control. Control can be information or behavioral control. Learning more about AD and how to manage flares can provide information control, while behavioral control involves taking direct actions to change the situation. Behavioral control in AD management could include regular use of emollients (moisturizers), wet-wrap therapy, or actively avoiding known triggers.
Looking for the “silver lining:” One of the most powerful coping strategies can be selective attention to the positive aspects of a situation or finding the “silver lining” in a circumstance or event. For some children, it can be helpful to point out comparisons of your family to others who have a more severe disability.
Nguyen CM, Koo J, Cordoro KM. Psychodermatologic effects of atopic dermatitis and acne: a review on self-esteem and identity. Pediatric Dermatology. Mar 2016;33(2):129-135.