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Because our skin and its problems are visible to others, the impact that skin conditions can have on a person's quality of life may be considerable. It must be explored as part of the educational process for adolescents, their parents/guardians and teachers.

Society generally avoids the topic of skin problems. Models and media stars always appear to have healthy, glowing skin. The media's portrayal of what is beautiful and what is acceptable never includes a skin condition. In movie portrayals, only the "bad" guys have acne and the condition is seen as disfiguring and something to be ashamed of. The general public seems to agree with this notion and thus people with a skin condition are very aware of this.

When adolescence is reached a series of new concerns develop. Young people may start to become more self-conscious about themselves and feel that others are paying close attention to their appearance. They do not want to look different to those in their peer group, because they may not be accepted or tolerated.

While we can classify the severity of someone's skin condition clinically, their perception of the condition may not always match the severity. People with what might be considered minor skin conditions often report feelings of embarrassment, frustration, anger and even depression because of their condition. In some cases, people with skin conditions have less contact with the opposite sex, participate in sports less often, eat out less often, have impaired academic performance and even increased unemployment.

In understanding how someone feels about the way they look and the discomfort they may be experiencing, we can help that person deal with the difficulty of having a skin condition.

Self esteem and skin
When you first meet someone, the first thing you notice about them is their face and often their hair. It is little wonder that adolescents with a skin condition often suffer from self-esteem related problems. There is a strong association between the way you perceive yourself to look and the way you feel.

Self-esteem is made up of several factors including a person's self image, body image and attractiveness.

Self image takes into account how a person sees themselves as a whole or total person. This will include things such as body image, intelligence, personality and the way a person fits in with their peers and the greater community. If a person has a positive self image then they will feel generally happy with their life. A negative self image may cause a person to feel downcast and generally "low".

Body image is how an individual feels about themselves in relation to the way they think they look. For example," Does my skin look good? Am I too fat?" This means that if you feel happy about the way you look you will have a positive body image. If you do not like the way you look then you will have a poor body image. When a person reaches puberty their body inevitably changes physically, and so can the way that a person sees themselves.

A person's body image may be affected by many things including what is said by family, friends and peers. Exercise or lack of it can also affect a person's self- image. The media plays a large role in how adolescents view themselves. Adolescents are frequently shown unrealistic images of beautiful people with perfect bodies and flawless skin. Commercials advertising skin care preparations always use models with glowing skin.

It helps to reinforce society's view that clear skin is normal and beautiful and that skin which is blemished and marked is something to be ashamed of. While it is important to help adolescents find the right treatment for their skin condition, it is also very important for them to realise that the media can create unrealistic goals.

Attractiveness to others, defined by some people as sex appeal, is not necessarily related to physical beauty but also includes factors such as personality and intellect. People are attractive to others in different ways and to varying degrees.

Self-esteem takes into account all of the above factors and generally refers to the way a person feels about themselves. People who have low self-esteem may feel inadequate or inferior to others. They may lack confidence and feel depressed and anxious a lot of the time. On the other hand, people with high self-esteem are positive about life and tend to be confident and happy. Feeling good about ourselves and about how our skin looks is an important part of achieving a positive and happy outlook on life.

It is very important not to underestimate the impact that acne can have on a student's emotional well-being. When approaching puberty, the development of acne can be quite devastating. It comes at a time when adolescents are "finding" themselves and creating their "identity". Therefore, one cannot assume that a "few pimples" do not cause any anxiety.

Acne affects the face (it may also affect the chest, back and shoulders) and, because of this, acne sufferers cannot "hide" the condition and hope that it goes away. Many adolescents feel that their acne is a very real problem, despite the fact that it does not cause general ill health or shorten their life-span. Some fashion their hair to hide their face, sit in a particular way to limit vision of their face, avoid the limelight in the classroom situation, and place their hands over the affected areas.

Some of the concerns of young people with atopic eczema may differ to those with acne, particularly because eczema is not as common and some have already had eczema for years before they reach adolescence. Atopic eczema is an irritating and extremely itchy condition that often makes the sufferer feel irritable. Students with atopic eczema may have difficulty concentrating because of the itch.

Most eczema sufferers will become aware of the lack of understanding about eczema among their peers by the time they reach adolescence. For example, some with eczema may have been made to feel that they have a contagious disease. This may have been highlighted by a lack of acceptance in a person's peer group.

The notion of having a contagious or infectious skin condition such as tinea and warts can distress some people. Those with tinea may experience feelings of embarrassment when they go swimming as their feet are exposed and others may see their condition. Some people fear catching warts from others with the condition through having some type of physical contact, such as holding hands.

An understanding of the nature of transmission of the infection and the ease with which it can be prevented is an important part of reducing the impact for those affected and their family and friends.

© 2002, Department of Dermatology, St. Vincent’s Hospital Melbourne, Victoria Parade, Fitzroy, Victoria 3065 Australia.