Body Image Issues in Dermatology
JOHN Y. M. KOO
WITH REGARD TO THE SKIN
A discussion of body image would not be complete without considering its interconnections with the field of dermatology. The importance of the skin for an individual's psychosocial equilibrium can easily be appreciated. First and foremost, the skin represents the "outward packaging" of our being. The cutaneous surface is what society initially perceives; for that reason, having a healthy, unblemished skin enhances one's self-esteem and identity. As discussed in Barnard's book Touch: The Foundation of Experience, many psychological studies have attested to the importance of cutaneous, tactile experience that is empathic and stimulatory in the development of healthy body image and psychological differentiation of self from others. Moreover, even in the 21st century, in some societies skin pigmentation unfortunately still determines social rank and status, either explicitly or implicitly. In addition, numerous psychological studies have demonstrated that those who are afflicted with visible, disfiguring disorders are more likely to be stigmatized and ill-treated than those with obvious physical disabilities.
Having a presentable skin surface is usually a prerequisite for maintaining optimal body image. Disfigurement, disease, or a blemish on the skin can lead to embarrassment, humiliation, and other negative body image experiences, which in turn can diminish self-esteem and engender depression and other psychological difficulties. For example, in 1997 Rapp and his colleagues found that as many as 25% of patients with psoriasis have wished that they were dead at some point in their lives because of it, and about 8%