title: Appearance self-esteem in systemic sclerosis--subjective experience of skin deformity and its relationship with physician-assessed skin involvement, disease status and psychological variables.
abstract: OBJECTIVE
  To determine the importance of skin deformity in systemic sclerosis (SSc) relative to other disease stressors and to find psychological correlates of appearance self-esteem (ASE) after controlling for disease status.
  
  
  METHODS
  Disease-related stressors, symptoms, physical and psychological functioning, social support, coping styles, cognitions and ASE were assessed in 123 patients with SSc. A rheumatologist determined disease duration, SSc subtype, presence of organ involvement and skin-thickness scores. Stepwise hierarchical regression analysis of disease-related cognitions on ASE was performed after controlling for selected variables.
  
  
  RESULTS
  Skin deformities proved a core stressor of the disease, only preceded by fatigue. Physician-assessed disease status, including modified Rodnan skin score, was unrelated to ASE. Sex, self-reported functioning and symptoms were related to ASE and used as control variables. Both acceptance and anxiety correlated strongly with ASE. The stepwise regression procedure only identified the disease-related cognition acceptance.
  
  
  CONCLUSIONS
  In SSc, ASE proved unrelated to the extent of skin thickness. Psychological interventions aimed at boosting ASE should primarily target the psychological factors acceptance and anxiety.
authors.affiliation: 1Department of Rheumatology, St Maartenskliniek, Nijmegen, The Netherlands. w.vanlankveld@maartenskliniek.nl
authors.forename: W G J M
authors.initials: WG
authors.lastname: van Lankveld
authors.forename: M C
authors.initials: MC
authors.lastname: Vonk
authors.forename: H
authors.initials: H
authors.lastname: Teunissen
authors.forename: F H J
authors.initials: FH
authors.lastname: van den Hoogen
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D004522:Educational Status; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012595:Scleroderma, Systemic / Q000473:pathology / Q000523:psychology*; D012649:Self Concept; D012867:Skin / Q000473:pathology; D012944:Social Support; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology