Internalized stigmatization in dermatological diseases (acne vulgaris, vitiligo, alopecia areata)

Because of the visible nature of the lesions, dermatological diseases discriminate the individual from others, in other words stigmatizes the patient. Internalized stigma, another aspect of the stigma, is the adoption of negative attitudes and stereotypes of the society regarding persons' illness. According to available current literature The Internalized Stigma Scale has not been applied to acne vulgaris (AV), vitiligo and alopecia areata (AA) patients. The primary aim of this study was to investigate the İnternalized stigma state of AV, vitiligo and AA patients and to identify the factors influencing internalized stigma. 150 patients (50 AV, 50 vitiligo, 50 AA) who applied to Akdeniz University, Faculty of Medicine, Dermatology and Venereology Department have been consecutively enrolled in this study. Socio-demographic characteristics of the patients and other parameters which may influence internalized stigma were recorded. Disease severity scores such as Vitiligo European Task Force (VETF) score, Vitiligo Disease Activity (VIDA) score, Severity of Alopecia Tool (SALT) score and Food and Drug Administration (FDA) acne global score were used to assess disease severity. Also patients have answered Internalized Stigma Scale, Dermatology Life Quality Index, Perceived Health Status General Health Questionnaire and Acne Quality of Life Scale. In our study, the Cronbach's alpha coefficient for the whole scale was calculated as 0.91 for AV, 0.91 for vitiligo, 0.93 for AA. The reliability coefficients of all subscales except for alienation and social withdrawal in AV and vitiligo, alienation in AA, perceived discrimination, and social withdrawal were not 0.70 or higher. The total mean Internalized Stigma Scale scores for AV and AA in our study were determined to be high. In vitiligo patients, the mean total score of Internalized Stigma Scale was found to be higher but smaller of other two diseases. These findings are an indication of internalized stigmatization in these diseases. There was no significant correlation between disease severity scores (SALT, FDA global, VETF and VIDA scores) in our study with respect to the median values. In these diseases where the patients have a stigmatizing feature, the psychological factors affecting the patient such as stigmatization and quality of life should be considered when assessing the clinical severity of the patients. The psychological and social effects of the disease can be better understood by detecting at levels of internalized stigmatization and the factors affecting it in patients. This may affect the approach to treatment of the disease.