There are a large number of studies that have shown that any form of physical illness during childhood increases the risk of psychological difficulties for the child (Lavigne & Faier-Routman, 1992; Wallander & Varni, 1998). There is also evidence from a few studies about the specific impact of a skin disorder on childhood psychological problems. For example, Absolon et al. (1997) found that children with eczema had higher rates of behavioural problems than healthy children. Rates of psychological difficulties are even higher among young people with acne and up to a half of 12-20-year olds with acne have been shown to have psychological or social problems (Smithard et al., 2001).
Early studies in this field focused on measuring levels of psychological distress, or the presence or absence of psychological difficulties in the child or parent. However, whilst the presence or absence of psychological distress or disorder is one important outcome measure, it is quite a narrow way of defining psychological adjustment. Hence there has been increased interest in other types of outcome measure, such as quality of life, to attempt to encompass other important areas of experience, such as social and educational factors.
There are now several measures of quality of life for skin conditions that have been developed specifically for children and which help us to access the child's view of the impact of a skin condition on themselves. For example, the Children's Dermatology Life Quality Index (Lewis-Jones & Finlay, 1995) is a generic assessment tool for use with all skin conditions and it comes in both a cartoon and a written version (Holme et al., 2003). It consists of 10 questions about the impact of the child's skin condition on their everyday life, such as taking part in leisure activities or going to school. This measure has proved very useful in providing a way of comparing the impact of different types of skin conditions on children from the child's own viewpoint. For example, atopic eczema has consistently been shown to have a high impact on quality of life of children (Chuh, 2003). The highest scores reported using this measure have been for the very rare form of dystrophic epidermolysis bullosa (Horn & Tidman, 2002). Other disease-specific measures of quality of life have been used as part of treatment evaluation (Fehnel et al., 2002).
These measures of quality of life have proved useful because it becomes possible to assess the impact of a skin condition from the child's own viewpoint. It is also then possible to compare across different conditions, or to compare the impact of different types of the same condition, as well as to evaluate the impact of treatment from the child's viewpoint.
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