Children feel distress over skin ills.

WASHINGTON -- Physicians were less able than parents and children to predict psychosocial dysfunction in pediatric patients with chronic skin conditions, judging from the findings of one study.

Overall, the social impact of the child's appearance was the best predictor of emotional impairment, Karen S. Mallin, Psy.D., said at the annual meeting of the Association for Psychocutaneous Medicine of North America.

Dr. Mallin, a clinical psychologist at the University of Florida, Miami, interviewed 188 pediatric dermatology patients, 250 parents, and 233 physicians for her study; 88 of the children came from a public clinic and 100 from a private clinic. All the children had a chronic skin condition; the most common dermatologic diagnoses were acne vulgaris (19.8%), atopic dermatitis (16.5%), nevus (8.9%), alopecia areata (8.0%), and verruca vulgaris (7.6%).

Dr. Mallin gathered demographic information and possible predictors of psychosocial dysfunction. As part of her assessment, she administered the Pediatric Symptom Checklist, Child Behavior Checklist, and Children's Dermatology Life Quality Index.

A majority of children and their parents (132 children and 141 parents) reported that the child's skin disease had a negative effect on the child's emotional health. In contrast, the majority of physicians surveyed (148 of 233) reported that the skin disease did not have a negative effect on the child's emotional well-being.

The factors most significantly associated with the child's psychosocial dysfunction were the parent's rating of the child's appearance and the presence of developmental problems in the child.

The physician's rating of the course of the disease, parents' income, the number of days missed from school for physician visits, and the number of prescribed medications also correlated with the child's psychosocial dysfunction.