Partridge, J. and Rumsey, N.
Skin scarring: new insights may make adjustment easier.
British Medical Journal (BMJ), 326 (7392).
Available from: http://eprints.uwe.ac.uk/11967
Publisher's URL: http://dx.doi.org/10.1136/bmj.326.7392.765/a
Skin scarring is a clinical problem that can cause many psychological and social difficulties—some as a result of the cause of the scarring (for example, trauma), some related to the effects (for example, itching), and many to the appearance of the scar itself. In the review by Bayat et al their argument that a decision to treat will depend on site, symptoms, severity of functional impairment, and stigma would be enhanced by the inclusion of two crucial insights from recent psychological literature, insights that can make it much easier for patients to adjust to these problems.
Firstly, much research has now confirmed that the seriousness of psychosocial sequelae is not positively correlated with the severity, size, or location of scarring. It is therefore important in the clinical examination and assessment process that doctors do not make assumptions about the psychosocial impact of scarring—it is important to ask patients about how self conscious they feel, for example, and how noticeable they feel the scar is to others because these factors are likely to be more predictive of distress.
Secondly, recognising that even with the skills of surgeons and others, scars cannot yet be made to disappear has prompted new psychosocial interventions to be developed for patients distressed by disfigurements of any kind, including scarring, to their face, hands, and body. These have focused on the strengthening of self esteem and communication skills (so as to manage the reactions of other people) and are available in various formats including in self-help guides produced by a charity, Changing Faces (for example, Everybody's Staring at Me! How to Communicate When You Have an Unusual Face). These new interventions are becoming known to psychologists across the NHS and can be delivered by individual psychologists or through a centralised referral unit such as the outlook unit at Frenchay Hospital, Bristol.
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