Amanda Clark, RN, MA.
Deputy Editor, Professional Nurse
The results of an inquiry into the impact of skin disease on people’s lives were recently published by the All-Party Parliamentary Group on Skin (APPGS).
The findings, based on patient accounts, submissions from professionals - such as consultant dermatologists, nurses, GPs and health economists - and the public led the group to recommend that a range of issues be considered both in developing, and subsequently delivering, health-care services.
The inquiry focused mainly on the psychological and social impact of skin diseases, and those considered by the inquiry are listed in Box 1.
The Government classifies most skin diseases as ‘minor ailments’, but evidence to the inquiry clearly demonstrated that this is wholly inappropriate.
Having a skin disease was shown to have adverse effects on almost every aspect of a sufferer’s life. The inquiry learnt that many skin conditions could result in disability levels equivalent to those caused by angina, asthma, bronchitis, arthritis, diabetes, hypertension and back pain. Skin diseases also have a marked impact on the lives of other family members and carers.
The psychological and social problems associated with skin conditions were shown to be significant, with many sufferers describing how their disease had led to them becoming socially isolated. It also caused marked sleep deprivation and low self-esteem. Parents of children with atopic eczema described feelings of guilt, exhaustion, frustration, resentment and helplessness.
The inquiry learnt that the process of diagnosing a skin disease could be prolonged, with delays often occurring due to a lack of dermatology training for non-specialist health professionals. Many patients reported managing their skin condition themselves, having long given up on the view that doctors could help them.
The evidence to the inquiry highlighted the prejudice and discrimination that people with skin disease often face because of their appearance. Many sufferers consequently withdraw from activities and situations - for example, they avoid parties, meeting new people, being photographed, public speaking and taking part in sporting activities that may involve exposing affected areas of skin.
Evidence to the group indicated that people with skin disease were also often limited in their choices of career, owing to prejudice and interpersonal problems that may be encountered in the workplace. Those with occupationally acquired skin disease often felt they could not not continue in their job, forcing many to abandon their chosen careers.
Treatment and support
The APPGS report highlights the shortage of health professionals specialising in dermatology. Lack of training for those working outside secondary-care specialist units often leads to inadequate or inappropriate management of skin diseases.
Resource restrictions were also a problem, with evidence showing that newer, more expensive, treatments were being denied to some patients by trusts preoccupied by staying within budget and thus offering cheaper treatment options only.
The substantial number of personal accounts received by the inquiry provided examples of how people with skin disease felt they had been discriminated against by health-care providers, as well as at work and in their leisure pursuits.
Patient support groups were highly praised, particularly for their provision of information. A lack of resources, training and specialists in dermatology were blamed for gaps in information provision in the NHS. The APPGS recognised that well-informed patients were more likely to comply with treatment, adjust to their condition better and have better recovery.
On the basis of the evidence, the group concluded that, in developing health policy, the Government does not appropriately consider the impact of skin disease on people’s lives.
They found that resources were lacking in this area of health care and concluded that training of non-specialist health professionals was very limited.
The report recommends that health policy in dermatology should be aimed not only at ensuring the management of the physical symptoms of skin disease but also addressing issues relating to the patient’s quality of life.
Where to find out more
For copies of the Report on the Enquiry into the Impact of Skin Diseases on People’s Lives, tel: 020-7591 4833. It costs £15; £11.75 to APPGS members.
Membership information: Administrative Secretary, All-Party Parliamentary Group on Skin, 26 Cadogan Square, London SW1X 0JP. E-mail: firstname.lastname@example.org