Jul 12, 2016

Of Psyche and Skin: Beneath the Beauty Bias

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By Larisa M. Lehmer, MD

Imagine it’s the night before an important job interview.  You have all the experience the target company could wish for and have everything carefully planned including your tie, kerchief and shoes all ready for the big day.  Turning to face the mirror you feel your heart sink; you see the silvery scales overlying a fleshy patch of salmon-colored skin in front of your right ear that herald the return of the psoriasis you have worked so hard to get rid of.  Then again, you might find a crop of acne pustules that has burst forth over the center of your forehead after weeks of being kept at bay by the latest-and-greatest skin-care regimen. You may yet discover the vivid flush of rosacea expanding across your cheeks and nose that no amount of makeup will cover.

Regardless of which of these equally anxiety-producing alternatives you encounter, you realize that if you cannot subdue or conceal your skin’s latest eruption, you will have an uphill battle to secure the job. Not only will you have to demonstrate your professional skills, but you’ll need to actively counteract your potential employer’s subconscious misgivings about your health and job fitness that your skin’s blemishes have set in motion. Instead of reviewing your resume one last time, you frantically search through the numerous bottles and tubs in the medicine cabinet for the cream or ointment that will produce the “miracle overnight cure.”.

This all-too-familiar scenario underscores that, in addition to the worries of the unknown and frustrations of enduring long and expensive treatments for chronic conditions, there is significant psychosocial stress inherent in living with dermatologic diseases, which by nature are highly visible. There are a variety of ways the stress of dealing with chronic skin disease can manifest themselves, but major depression constitutes the most common associated health issue.   Furthermore, those struggling with psoriasis have suicidal thoughts three times more often than the general population. Behavioral anthropologists explain society’s discrimination against individuals with skin problems (in addition to other physical ailments) is rooted in humankind’s centuries-old practice of using an individual’s outward appearance as an indicator of overall health. Leprosy, (Hansen’s disease), was first reported in 600 BC and serves as both the longest-running and most striking excuse for ostracization for an affliction of the skin. Despite the advances in knowledge achieved over two millennia, a 2013 survey of 1,675 rosacea patients revealed that over half admitted to avoiding face-to-face contact.

Not surprisingly, the thoroughly ingrained and pervasive nature of our beauty bias carries significant economic implications. Frieze et al. studied the 10-year post-graduate earnings of MBA students, and found that for males, increasing attractiveness correlated with higher starting and subsequent salaries while it was associated with more rapid salary growth for females. Even more, telling is the existence of a 5-10% wage-deficit, or “plainness penalty” for employees rated less attractive that is greater than the reciprocal bonus, i.e., “beauty premium.” The pressure to look good drives the 7% annual growth of the global beauty industry worth $160 billion, of which skin care alone accounts for more than $24 billion. Considering that physical attractiveness is a better determinant of lifetime earnings than education, it is understandable that Americans spend more each year on their appearance than they do on their smarts! Beyond the promises of a good return on investment from a financial perspective are the substantial romantic, social, emotional, and mental health benefits garnered by the good-looking.

Since we still live in a world that values looks over learning, treating dermatologic disorders not only alleviates physical suffering but doing so profoundly impacts the psychosocial and economic well-being of those afflicted. To this end, there is a growing attempt to address the mental health factors surrounding dermatologic disease in the newly developed field of psycho-dermatology. Skin disease affects both how patients perceive themselves and how others perceive them. To this end, important advocacy work is being accomplished by groups like the National Psoriasis Foundation to expand awareness of, and medical/psychiatric access for, individuals in the process of coping with the social, economic, and psychological ramifications of dermatologic diseases.

* A disorder that causes predominantly central facial redness and flushing and may also include skin thickening, pustules, and reddening of the eyelids.

REFERENCES

1 Grossbart T. The emotional impact of skin problems. Psychology Today Jan 9, 2010. https://www.psychologytoday.com/blog/skin-deep/201001/the-emotional-impact-skin-problems (Accessed June 2016).

2 Hilton L. Psoriasis impact goes more than skin deep: managing psychosocial burden of psoriasis requires going beyond prescribing medications. Dermatology Times July 14, 2014. http://dermatologytimes.modernmedicine.com/dermatology-times/RC/psoriasis-impact-goes-more-skin-deep...  (Accessed June 2016).


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