Dermatological diseases and cumulative life course impairment

The current research on life course perspective and quality of life has focussed primarily on medical conditions such as diabetes, cancer, hypertension, etc., or on post-surgical conditions and implications. This book, therefore, proves to be of value in the area of impact of disease on life quality by incorporating dermatology into the vast expanse of existing literature on other diseases. Skin conditions, as has been recognized in clinical practice, have major and long lasting psychological implications for those who suffer from these, and often reflect in their personality and adjustment. The field of psycho-dermatology has now emerged to assess and address such issues. This current volume extends its scope beyond psychodermatology, incorporating both the influence of psychological factors on dermatological conditions and vice versa.

The volume is divided into four sections, further divided into fifteen chapters. The Introduction starts with an overview of life span and life course (LSLC) approach to dermatological diseases. In this chapter a thorough review of the various psychological and psychosocial constructs pertaining to the onset, severity and impact of dermatological conditions is given. By using a cumulative standpoint, the chapter explicitly underlines the underlying concept of cumulative life course. Detailed account of the psychological and sociological model is discussed, backed by extensive literature review. From the psychological standpoint, the impact of early life experiences on later life, and the cumulative nature of the negative exposure and possible trauma due to illness faced by those suffering from skin disorders have been discussed. Not only the individual factors such as vulnerability and resilience, but social aspects such as impact on agency and social networks have also been addressed. By interlinking the dermatological conditions with early life experiences and their consequent impact on later life, the chapter forms a coherent picture of the interplay between psychosocial factors and the genetic-medical model of skin diseases.

The second section, “Life Course, Life Course Modeling and Life Course Damage”, seeks to explain the life course impairment in terms of the existing models. The first chapter in the section employs the biopsychosocial model in the understanding of dermatological illness. The chapter focuses on the importance of allostatic load and the accumulation of stressors and exposure as important contributors to chronic illness. The second chapter in this section attempts to understand the cumulative effects of exposure and risk and the protective factors on health, by employing three formal mathematical models to facilitate understanding.

The third section, “Cumulative Life Course Impairment and its Assessment”, seeks to formalise the clinical and research findings by means of employing standardized assessment tools. The first chapter under this section taps on the current trend of quality of life (QoL) assessments in various disorders and enlists various scales used for QoL assessment for different skin conditions. Both concepts are important to quantify the impact of disease on patients’ life and well-being. The next chapter deals with the long term impact of skin disorders, that may influence long term goals, planning and decision making of the inflicted individuals. Chapter 3 describes how to construct assessment procedures and scales. Since cultural factors are highly relevant in the understanding of quality of life and life course impairment, this chapter highlights the basic processes essential for construction and validation of such instruments. Not only culture, but different skin conditions come with their own set of problems and consequences, and hence different instruments may be developed for the different conditions. The last chapter, “Cumulative Life Course Impairment: Identifying Patients at Risk”, is one of the most important chapters in this section as it emphasises early identification to prevent negative consequences of skin conditions. The importance of early identification and dealing with stigma cannot be overemphasised. This chapter highlights the important factors in identification such as severity, course, onset, stigmatisation, social support impact on profession, mood or personality traits, coping strategy, QoL and other co-morbidities. A detailed clinical interview along with assessment is, therefore, essential to proper diagnosis and therapy planning.

The last section, “Cumulative Life Course Impairment in Dermatological Patients”, gives a comprehensive review of cumulative life course impairment (CLCI) in different dermatological conditions. The section is impressive in its layout, with focus on theoretical grounding, clinical practise as well as empirical evidence. The first chapter in this section provides evidence-based work for CLCI in psoriasis. It delineates CLCI into social as well as physical aspects ranging from stigmatisation, depression to pain and arthritis, and its further consequences on the individual. It concludes with a section on highlighting the possible protective strategies against CLCI for psoriasis. The next chapter focuses on epidermolysis bullosa, highlighting both individual consequences and impact as well as the impact of the disease on the family of afflicted individual.

The next chapter in the section focuses on vitiligo, and highlights the psychosocial impact of the disease, and presents a detailed review of literature as well as data from two empirical studies, highlighting the negative impact of stigmatisation and its role in contributing to progressively poorer quality of life. The studies interlink the findings with age, quality of life and other health disturbances. The next chapter deals with CLCI in melanoma and non-melanoma in skin cancer, and highlights the effects of chronic and life threatening nature of the disease on the patient. It also highlights the psychological effects of living with the disease and possible post-surgical trauma in some cases. The scarcity of research in this area is also highlighted, and a need for further research is emphasised.

The next chapter in this section deals with CLCI in chronic wounds. The chapter highlights the psychological implications of chronic wounds and possible sociocultural consequences in some countries. The chronic nature and co-morbidities are discussed and the need for early identification, accurate diagnosis, assessment and treatment planning in such cases is identified. The following chapter deals with CLCI in other chronic or recurrent dermatological disorders, such as psychosocial implications of various skin diseases, and highlights the need for research with other skin diseases which may not be life threatening but are chronic and debilitating in their psychosocial effects. CLCI studies for various disorders such as hand eczema, atopic eczema, acne, hidradenitis suppurativa among other disorders are discussed. The successive chapter discusses the CLCI studies across cultures, economic and medical systems. The cross cultural impact of a dermatological disease on a subject's life as well as empirical evaluation of instruments are discussed. The final chapter in the volume, “Patients’ Narratives” presents two longitudinal case studies, describing a patient's insight into what has been previously discussed, thereby lending a more practical orientation to the preceding sections of the book.

Overall this is a comprehensive, well researched and organized work in the field of dermatology and CLCI. Combining the CLCI, psychosocial and medical perspectives has helped in suggesting treatment plans that not only aid in physical health but also psychological well-being. The book will be of great help in planning treatment and research in the field of dermatology.