Skin scar pre-conceptions must be challenged: Importance of self-perception in skin scarring
Brown, B. , Moss, T. P. , McGrouther, D. and Bayat, A. (2010) Skin scar pre-conceptions must be challenged: Importance of self-perception in skin scarring. Journal of Plastic, Reconstructive & Aesthetic Surgery, 63 (6). pp. 1022-1029. ISSN 1748-6815
Publisher's URL: http://dx.doi.org/10.1016/j.bjps.2009.03.019
Introduction: Greater objective scar severity and visibility should intuitively cause greater psychosocial distress for patients. Previous research is contradictory and has often employed non-validated scar severity measures whilst neglecting patient-rated severity. The aim of this study was to assess the effects of objective and patient-rated scar severity, scar type and location on psychosocial distress. Methods: Patients were recruited from a specialist scar service at a plastic surgery clinic. Skin scars were quantitatively assessed using the “Manchester Scar Scale” (MSS) – a validated measure with high inter-rater reliability and correlation with histological and clinical findings. Scars were scored twice independently: first at consultation and later from photographs – their mean provided a final score. Patients also rated their scars as ‘very good’; ‘good’; ‘neutral’; ‘fair’; or ‘poor’ and completed the Derriford Appearance Scale (DAS24) and Dermatology Life Quality Index (DLQI). Results: Eighty-three patients (57 women, 69%), with an average age of 34 +/- 15 (16 – 65) years were recruited. Mean psychosocial questionnaire scores were: DAS24 45.8 +/- 17.9 (15 – 91); DLQI 7.5 +/- 6.6 (0 – 26). Participants had on average 2.4 +/- 4.3 (1 – 30) scars with an MSS score of 33.4 +/- 53.3 (5.4 – 480) and subjective score of 2.6 +/- 1.2 (0 – 4). Correlation between psychosocial distress and objective severity was not significant (Kendall’s tau: DAS24 0.16 p=0.07; DLQI 0.16 p=0.06), though was for psychosocial distress and subjective severity (Kendall’s tau: DAS24 0.47 p<0.0001; DLQI 0.58 p<0.0001). Patients with non-visible scars experienced greater psychosocial distress than patients with visible scars (mean difference: DAS24 10.4 p=0.030; DLQI 4.1 p=0.013). Scar type was unrelated to psychosocial distress. Conclusions: Patient-rated scar severity and scar visibility are correlated with patient psychosocial distress rather than clinician’s objective severity rating or scar type. Although counter-intuitive, results are consistent with research into other disfiguring conditions and should therefore form an integral part of clinical assessment. In addition to improving objective scar severity we recommend that treatment should address patient factors to improve self-perception and quality of life (QoL). Currently there are no measures that directly measure scar-related QoL, which should be developed in order to improve future management of scar patients.
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