Evaluation of perceived stress level, social appearance anxiety, and quality of life in patients with seborrheic dermatitis

Objective Seborrheic dermatitis (SD) is a chronic, recurrent skin disease characterized by erythematous patches and scaling. It is among the most common dermatological conditions, and the areas affected and severity of the disease vary from person to person. Similar to many other skin diseases, there is evidence that SD negatively impacts quality of life. Identifying the psychosocial impact level on these patients and potential influencing factors can provide valuable guidance in creating treatment strategies to maximize benefit for the patient. The aim of this study is to evaluate the psychosocial complaints of individuals with SD, compare them with a healthy control group, and investigate the differences. Additionally, by examining the relationship between these complaints and the clinical features and severity of the disease, this study seeks to support the identification of priority factors to consider during treatment planning. Materials and Methods A total of 100 SD patients and 100 healthy volunteers, aged 18-65, who visited the dermatology outpatient clinic were included in the study. Demographic characteristics of both the patient and control groups, as well as information related to the disease for the patient group, were collected and recorded. The Seborrheic Dermatitis Area and Severity Index (SDASI) was used to assess SD disease severity and activity. Quality of life, stress, and anxiety levels in both groups were evaluated using the Dermatology Life Quality Index (DLQI), Perceived Stress Scale (PSS), and Social Appearance Anxiety Scale (SAAS). Results Of the 100 patients included in the study, 51% were female and 49% were male, with a mean age of 29.11 ± 9.39 years.The control group consisted of 61% females and 39% males, with a mean age of 29.19 ± 7.38 years. Both groups showed similar distributions in terms of age and gender (p>0.05). Among the patients, 19% had isolated scalp involvement, 59% had involvement of the face and scalp, and 22% had involvement of the face, scalp, and chest; there were no patients with isolated face or chest involvement. The mean Dermatology Life Quality Index (DLQI) score was 7.66 ± 4.19 (range: 0-21) in the patient group and 0.55 ± 1.01 (range: 0-4) in the control group, with a significantly higher DLQI score in the patient group compared to the control group (p<0.001). The mean Social Appearance Anxiety Scale (SAAS) score was 39.67 ± 12.44 (range: 16-65) in the patient group and 24.34 ± 5.39 (range: 15-37) in the control group, indicating significantly higher social appearance anxiety in the patient group (p<0.001). The mean Perceived Stress Scale (PSS) score was 18.61 ± 6.23 (range: 3-29) in the patient group and 9.43 ± 4.23 (range: 0-20) in the control group, with significantly higher perceived stress levels in the patient group (p<0.001). Both the patient and control groups showed similar scores for DLQI, perceived stress levels, and SAAS across genders (p>0.05). No significant relationships were observed between patient age, age of SD onset, duration of SD, and frequency of SD flares with DLQI, perceived stress, and social appearance anxiety (p>0.05). There was a significant relationship between SD localization and both DLQI and SAAS (p=0.015 and p<0.001, respectively). Patients with involvement in all three regions (scalp, face, and chest) had higher levels of quality of lifeimpairment compared to those with fewer areas affected,with a higher proportion of these patients experiencing moderate or severe quality of life impairment (p<0.001). Similarly, patients with all three areas affected had significantly higher SAAS scores than those with fewer areas involved (p<0.001). When erythema, scaling, and pruritus severity were analyzed by affected area, it was observed that median severity levels for erythema, scaling, and pruritus were significantly higher in the scalp compared to the face and trunk (p<0.001). The mean Seborrheic Dermatitis Area and Severity Index (SDASI) score was 3.84 ± 1.38 (range: 1.20-7.00). Patients with moderate or severe impairment on the DLQI had significantly higher SDASI scores compared to those without impairment (p<0.001). Additionally, there was a strong positive correlation between SDASI and both DLQI and SAAS, and a moderate positive correlation with PSS (r=0.776, p<0.001; r=0.804, p<0.001; r=0.695, p<0.001, respectively). Conclusion The quality of life, social life, and stress levels of individuals with seborrheic dermatitis (SD) are impacted by the disease process. This impact is independent of patient age, age at disease onset, duration of SD, and frequency of SD flares; however, patients with widespread or severe involvement experience a higher degree of impairment. Patients with scalp involvement report more intense pruritus compared to other affected areas. When planning skin-targeted treatments for patients with extensive/severe disease or scalp involvement, it may be beneficial to consider these patients heightened psychosocial impact by addressing their complaints and prioritizing their treatment needs. Keywords: seborrheic dermatitis, stress, quality of life, anxiety.