Introduction
Understanding public perceptions of individuals with dermatological diseases is critical for several reasons. First, they directly influence the social and emotional well-being of individuals living with these conditions as this type of disease often provokes negative perceptions, stereotypes and stigmas which lead to feelings of embarrassment and isolation among affected individuals, ultimately affecting their quality of life and overall health [1, 2]. Second, these feelings of embarrassment can prevent sufferers from seeking medical advice or from strictly adhering to courses of treatment. For this reason, misconceptions and lack of awareness about skin diseases may also lead to delayed diagnosis, worsening symptoms and complications, and increased healthcare costs [1, 3]. In order to address these problems, healthcare policies and funding priorities must be reconsidered so that positive and accurate perceptions of skin conditions can proliferate and lead to increased support for research work related to skin diseases, improved access to healthcare services, and enhanced patient-centred care [2, 4].
Due to the many issues highlighted here, the main objective of this review is to explore and analyse the perception, knowledge and attitude of the society towards individuals with skin diseases in the hope of countering some or all of these issues.
Understanding skin diseases
Types and common features
Skin diseases include a wide range of conditions that affect the skin, hair, nails, and mucous membranes. These conditions can be broadly classified as inflammatory, infectious, autoimmune, genetic, and neoplastic ones [3, 5]. Examples of inflammatory skin diseases include eczema, psoriasis, and acne, which are characterized by redness, swelling, and itching. Infectious skin diseases, such as fungal infections, bacterial infections (such as cellulitis), and viral infections (such as herpes simplex), are often characterized by rashes, blisters, or ulcers [2, 6]. Autoimmune skin diseases, such as lupus erythematosus and dermatomyositis, involve the immune system attacking healthy skin cells, leading to inflammation and tissue damage. Genetic disorders, such as ichthyosis and epidermolysis bullosa, present with abnormal skin growth, fragility, and ulceration of the skin. Finally, skin tumours, such as melanoma, basal cell carcinoma, and squamous cell carcinoma, arise from abnormal cell growth and can be benign, malignant, or malignant [1, 6–8].
Each skin disease has unique characteristics in terms of symptoms, triggers, severity, and treatment options. Understanding these differences is essential for accurate diagnosis and the development of treatment plans that are tailored to each individual case, based on the available financial resources and the individual needs of the patient [4, 9].
Impact on physical and psychological health
The impact of skin diseases extends beyond physical symptoms, as they significantly affect the psychological and emotional health of patients. Skin diseases can cause pain, discomfort, disfigurement, and functional limitations, affecting daily activities, self-esteem, and quality of life [10, 11].
Some patients with visible skin lesions experience social stigma, discrimination, and negative perceptions of body image, which can lead to feelings of embarrassment and social isolation. Stress, anxiety, depression, and low self-esteem are common among people with chronic or severe skin conditions [10, 12].
In addition, skin conditions can cause changes in sleep patterns, interfere with social interactions, and influence occupational or educational activities. For example, chronic itching, pain, and skin sensitivity can contribute to emotional distress and psychiatric comorbidities, highlighting the interconnectedness of physical and mental health in skin conditions [11, 13].
Prevalence and incidence
The prevalence and incidence of skin conditions vary widely depending on geographic location, demographics, environmental factors, and genetic predisposition. Common skin conditions, such as acne, eczema, and fungal infections, have high prevalence rates worldwide, affecting millions of individuals across all age groups [5, 7, 14].
Some skin conditions show regional differences, influenced by climate, lifestyle factors, socioeconomic status, and access to healthcare. For example, conditions, such as cutaneous leishmaniasis and tropical ulcers, are more prevalent in tropical and subtropical regions, while cold-related skin disorders such as frostbite and chilblains are more common in cold climates [14, 15].
In addition, the incidence of skin cancer, including melanoma and non-melanoma skin cancer, is on the rise, attributed to increased sun exposure, population aging, and changing environmental factors. Epidemiological studies and public health policies play vital roles in monitoring trends, identifying risk factors, and implementing preventive measures to reduce the burden of skin diseases at the population level [5, 14, 16, 17].
Methods
To conduct this narrative literature review, a comprehensive search using the most common databases for healthcare research was applied. These databases included PubMed, Scopus, Web of Science, and Google Scholar. The keywords that were used to obtain the final dataset were as follows: (“perception” OR “attitudes” OR “knowledge” OR “stigma”) AND (“skin diseases” OR “dermatological conditions” OR “visible skin disorders”). Boolean operators (AND, OR) were applied to broaden the search. The search included studies published between January 2000 and December 2024.
Inclusion criteria
Given the aims of this review, inclusion criteria for the articles selected were as follows. Firstly, articles that focused on public perception, knowledge, and attitudes towards individuals with skin diseases. Secondly, articles that examined the impact of stereotypes, stigmas, media influences, and cultural factors were included. Furthermore, studies that provided insights into factors such as education, socioeconomic status, and personal experiences influencing perceptions were part of the selection criteria. We also included articles discussing the implications for healthcare practices and patient outcomes. Finally, all articles had to be peer-reviewed and published in English.
Exclusion criteria
The exclusion criteria were studies that did not focus on skin diseases, articles that were not available in their full format, and articles that had not been peer-reviewed, such as reports and theses.
Data extraction and synthesis
To counter the potential effect of bias and to ensure maximum reliability of the data, the literature review was performed independently by two reviewers. The data extracted from each of the identified studies included the following: the study design, population characteristics, key findings, and conclusions. Any discrepancies in the final dataset defined by each reviewer were resolved through discussion and consensus. Finally, the examination and synthesis of data were carried out using thematic analysis for rigor and clarity of results.
Quality assessment
The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist for narrative reviews. This assessment evaluates the methodological rigor, clarity of reporting, and relevance of the findings to the review’s objectives. Only studies that met a minimum quality threshold were included in the final synthesis.
Ethical considerations
As this study is a narrative review and does not involve direct human participants, formal ethical approval was not required. However, ethical considerations were observed by ensuring the integrity and accuracy of the literature review process, and proper citations and acknowledgments were given to the original authors of the studies included in the review.
Public perception of skin diseases
Stereotypes and stigmas
Public perception of skin diseases is often influenced by stereotypes and stigmas arising from societal norms, cultural beliefs, and media portrayals. For instance, in some cultures, vitiligo is wrongly believed to be contagious or a result of divine punishment, leading to social ostracism [18, 19]. Similarly, leprosy has historically been associated with uncleanliness in parts of Asia and Africa [3, 20]. Common stereotypes include associating skin diseases with poor hygiene or infection and personal neglect. These misconceptions can lead to social stigma, discrimination and negative attitudes towards individuals with visible skin lesions [18, 19]. Stigmatizing attitudes may manifest in the form of avoidance, ostracism or biased assumptions that are unrelated to the patient’s personality, competence or hygiene, and instead based solely on the appearance of their skin. Such attitudes can have profound psychological and social effects, contributing to feelings of shame, self-consciousness and reduced quality of life among affected individuals [6, 11, 20].
This calls for educational and awareness campaigns and intensive efforts to promote accurate knowledge, empathy and inclusiveness to challenge stereotypes and reduce stigma. Highlighting the diverse causes and manifestations of skin diseases also helps to dispel myths and promote a more understanding and supportive community environment for those affected [19, 21].
Media influence and misconceptions
The media representation of skin diseases plays an important role in shaping public perception and understanding these conditions. While media platforms can be effective and reliable sources of health information, they can also be vehicles for misconceptions, contributing to fear or stigma for people with skin conditions [22, 23]. Portraying severe or disfiguring skin conditions in dramatic ways can lead to exaggerated perceptions of disease severity, misinformation about appropriate treatment options, and may increase anxiety in the community. Furthermore, unrealistic standards of beauty as promoted in the media can contribute to body image dissatisfaction and self-esteem concerns, especially among individuals with visible skin conditions [22, 24]. This could reflect a divisive normalization mechanism, where individuals are categorized as “normal” or “other” based on visible skin differences. Such binary framing, reinforced by media images, can heighten stigma and social exclusion [25]. Efforts to improve media literacy by presenting diverse models of skin health and beauty can help mitigate the negative effects of misconceptions about skin conditions [21, 23].
Cultural and social factors
Cultural beliefs, social norms, and historical contexts influence a community’s perception and interpretation of skin conditions. Cultural practices related to skin care, hygiene, and traditional therapies may influence disease prevalence, treatment-seeking behaviours, and patterns of healthcare utilization [20, 21]. For example, cultural taboos or misconceptions about skin conditions may delay diagnosis and treatment, which can exacerbate health problems. In addition, social factors such as socioeconomic status, education levels, access to healthcare facilities, and discrimination in access to services can all exacerbate the challenges faced by individuals with skin conditions [21, 23].
Understanding the intersection of cultural and social factors is essential for developing culturally sensitive healthcare interventions, educational materials, and awareness programs. Collaborating with community influencers, educators, and healthcare providers from diverse backgrounds and specialties can help bridge gaps, address barriers, and promote equitable access to healthcare for skin conditions [19, 24, 26].
Types and common features influencing perception
Each skin disease has unique characteristics in terms of visibility, type, and severity of skin conditions significantly shape public attitudes. Disfiguring and highly visible diseases such as psoriasis or vitiligo often elicit stronger negative reactions compared to less visible disorders [1, 4, 19].
Anatomical variations of skin lesions significantly influence visual patterns and social perception, i.e. skin lesions in the face, especially forehead and nasal area, attract more attention and negatively affect the perception of positive emotions, the assessment of attractiveness, and the formation of social impressions. Similarly, patients who experienced upper lip pigmentation, will be at higher risk for cognitive burden, and decreasing attractiveness [27–29].
Public knowledge about skin conditions
Knowledge levels
Knowledge levels about skin conditions vary widely among the general population. While some conditions, such as acne and sunburn, are well known and easily recognized, others, such as rare genetic skin disorders or autoimmune diseases, may be less understood [30, 31]. Studies have shown that levels of knowledge are often influenced by factors such as education, age, and personal or family experiences with skin conditions [30].
Furthermore, awareness campaigns, public health initiatives, and media coverage also play important roles in shaping public knowledge about these conditions. Efforts to increase community awareness focus not only on recognizing symptoms and risk factors, but also emphasize the importance of early detection, preventive measures, and available treatment options [31, 32].
Sources of information
The sources from which individuals obtain information about skin conditions can greatly influence the accuracy and depth of their knowledge. Common sources include healthcare providers, educational websites, social media, family and friends, as well as traditional media such as television and print publications [30, 33]. Healthcare providers, including dermatologists, primary care physicians, nurses, and health educators, also serve as trusted sources of information for many individuals. These efforts are critical in educating patients about skin health, diagnosing skin conditions, and providing evidence-based treatment recommendations [31, 33].
As is well known, in recent years, the Internet and social media platforms have become increasingly influential in disseminating information about health and wellness, including skin conditions. However, the reliability and accuracy of online information can vary widely, leading to potential misinformation or misconceptions in the community [34, 35].
Accuracy of knowledge
Assessing the accuracy of knowledge about skin diseases among the general public is crucial for identifying gaps in knowledge and potential areas for education. Studies have shown that while many individuals may have a basic awareness of common skin diseases, their understanding of more complex or rare skin diseases may be limited [32, 36]. Although misconceptions and myths about skin health and skin diseases are uncommon, they may stem from outdated information, cultural beliefs, or distorted media images. Addressing and correcting misconceptions through educational channels and awareness campaigns is critical to promoting accurate knowledge and dispelling these myths [26, 31, 37].
Attitudes towards people with skin diseases
Empathy and support
Attitudes towards people with skin diseases vary widely, ranging from empathy and support to stigma and discrimination. Empathic attitudes include understanding and empathy for the challenges faced by individuals with skin conditions. Supportive behaviours include providing encouragement, seeking information, and advocating for inclusive policies and practices [31, 34].
Empathy and support play a critical role in promoting positive relationships between healthcare providers and patients, as well as fostering a supportive social environment for individuals with skin conditions [26, 32]. Empowerment initiatives, support groups, and educational programs can contribute to creating a more compassionate and supportive community [34, 36].
Discrimination, bullying and social exclusion
Conversely, some individuals may experience discrimination or social exclusion because of having skin conditions. Stigmatizing attitudes, stereotypes, and misconceptions can lead to unfair treatment, bullying, and exclusionary practices in a variety of settings, including schools, workplaces, and social gatherings [36, 38]. Discrimination and social exclusion due to skin conditions can significantly impact an individual’s quality of life [39].
Bullying is defined as repeated, demeaning insults or harmful behaviour directed at people perceived to be less powerful than others. Bullying comes in many forms, including physical, verbal, social, and online abuse, each with its own characteristics [40]. It has significant long-term negative effects on the psychological and social well-being of individuals with skin diseases. In a European study, Chernyshov et al. explored the prevalence, nature, and impact of bullying among patients with various skin diseases across different countries and age groups [41]. This study categorized bullying into physical, verbal, relational/social, and cyberbullying, with oral abuse and social isolation being the most prevalent forms. Chernyshov et al. found that the peak of bullying prevalence occurs between the ages of 13 and 15, but it can start as early as 3 years old and continue into adulthood. This study also revealed that individuals with visible skin conditions are often subjected to negative behaviours, including teasing, name-calling, and social isolation. These actions can lead to psychological distress, lowered self-esteem, anxiety, depression, and feelings of loneliness [41].
Addressing discrimination and promoting inclusivity requires concerted efforts at both the individual and public levels. Anti-stigma campaigns, diversity training, and policies that protect individuals from discrimination based on health conditions are essential steps towards creating a more inclusive and equitable society [18, 39–43].
Recommendations for future research
Longitudinal studies of attitude changes
Conducting longitudinal studies that track changes in attitudes towards dermatology over time is critical to understanding societal trends, identifying persistent stigmas, and evaluating the effectiveness of programs offered to address these effects. Collecting long-term data allows researchers to evaluate the impact of educational initiatives, media campaigns, and policy changes on public perception and attitudes [24, 30, 34]. Such studies can provide valuable insights into the factors that influence attitude changes, including generational shifts, cultural influences, and evolving healthcare practices. Longitudinal research also allows for the identification of demographic disparities in attitudes and the development of targeted interventions to address specific needs within diverse populations [34, 36, 37].
Interventional research on perception modification
Interventional research focusing on perception modification has a significant impact on promoting positive attitudes and reducing stigma towards skin diseases. Experimental studies, controlled trials, and behavioural interventions can evaluate the effectiveness of different approaches such as educational interventions, empathy-building exercises, and storytelling campaigns [19, 22–24, 34].
Collaborative efforts across different sectors
Collaboration between researchers, healthcare providers, advocacy organizations, and community stakeholders is essential in designing and implementing effective perception modification interventions. Outcome measures may include changes in knowledge levels, empathy scores, stigma reduction, and attitudes towards seeking medical care for dermatology [33, 36].
Conclusions
This review has explored multifaceted aspects of public perception, knowledge, and attitudes towards individuals with skin diseases, highlighting the impact of stereotypes, stigma, and media influences on public perception and discussed implications for healthcare practices and patient outcomes. The findings also underscore the importance of targeted health promotion strategies, stigma reduction efforts, and compassion-building initiatives in healthcare practices. Improving public awareness, promoting early detection, and fostering supportive environments can improve the quality of life for patients with skin diseases and improve treatment outcomes and satisfaction.
