Childhood Eczema: An Environmental Scan
Table of Contents
3.2.5 Psychosocial Factors
The area of psychosocial factors regarding eczema is extremely important. Specifically, childhood eczema is known to have a dramatic impact on children from infancy through to teenage years. Although many children will outgrow eczema by the age of 11, the years leading up to this are crucial for personal and social development. The stigma associated with visible outbreaks of eczema is difficult to manage and for young children and teenagers, their self-esteem at particularly crucial times of development is affected. In addition, social interactions and participation in social activities are hindered. It is well documented that all skin diseases negatively impact quality of life and often individuals with eczema have low(er) self-esteem thus, emotional support in the form of support groups or other social organizations like a child’s camp can help close the gap on a child feeling isolated and provide a comfortable opportunity for social interaction with other people who share similar experiences (38;39). The stigma attached to having a condition that requires constant management, alienates the child from social situations and that severely impacts their family unit are all concerns that lay beyond the clinical understanding and management of how to diagnose, treat and manage the disease over the life course.
For parents of a child suffering with eczema, the discomfort and severe itching interrupts both the child and parental sleep cycles thereby worsening the entire families’ ability to cope and manage the eczema. In addition, pharmacological treatment such as antihistamines may also leave the child lethargic and irritable in the morning. Parents and children become sleep deprived and a parent’s ability to perform day-to-day activities is hampered whereas children may display behavioral issues due to a lack of proper and restful sleep. Similarly, throughout the life cycle scholastic, work and professional activities are affected by eczema through lost participation rates, illness days and the psychological factors such as avoidance of social situations associated with having the disease or caring for someone who is afflicted.
Emotional stress affects both the child and parent and for the child their stress can affect the severity of the disease. For example, at the height of the summer season when a child is unable to wear comfortable clothing for weather conditions such as shorts and t-shirts either because exposing their skin may worsen the condition or they are self-consciousness in exposing skin that is flaring with an eruption affects both the child and the parent. Similarly, stress itself can worsen an individual’s eczema, which is particularly important in cases of childhood eczema that continue through the teen years.
Specifically, research has investigated the relationship among stress reactions such as frustration and anger and the ‘itch-scratch’ cycle. However, among researchers it is acknowledged that the association between immune reactions and stress remain elusive and requires further research. In their systematic review of the literature regarding the impact of childhood eczema and stress, Hawkins summarized several different studies that showed children with more severe eczema also had an increased risk of certain psychological problems such as somatic complaints including stomach problems and excessive worrying. In addition, some research has uncovered conduct problems and children experiencing bullying at school (39;40). Support and programs aimed at reducing anxiety and depression is paramount for children in order to reduce the overriding burden of illness suffered by these children and subsequently their parents (39)
For a parent of a child with eczema the emotional stress can be overwhelming and the grief of what their child must endure is very real. Parents often feel guilty and have a difficult time watching their child suffer in pain and discomfort along with feelings of helplessness in not being able to either bring relief or eradicate the disease all together. Similarly, parents may become overwhelmed by severe sadness at what their child is missing in their young life. There are feelings of anger to others who stare, tease or are simply ignorant to their child’s suffering. Importantly for the family unit, the culmination of exhaustion, stress and emotional roller coaster for parents affects relationships and the marriage just as any chronic on-going stressful situation would for any family. Research published in the Archives of Disease and Childhood states that mothers of children with eczema showed stress levels that were on par and equivalent to mothers whose children had severe developmental and physical problems (4;40). This is an important finding for parents whose child (ren) are afflicted with eczema and requires further public education to help ease the burden of illness for families.