title: Skin scar preconceptions must be challenged: importance of self-perception in skin scarring.
abstract: Greater objective scar severity and visibility should intuitively cause greater psychosocial distress for patients. Previous research is contradictory and has 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. Skin scars were quantitatively assessed on two independent occasions using the 'Manchester Scar Scale' (MSS) - a validated measure. Scars were scored twice independently. Patients also rated their scars (from 'very good' [zero] to 'poor' [four]) and good completed the Derriford Appearance Scale (DAS24) and Dermatology Life Quality Index (DLQI). Eighty-two patients, with an average+/-SD (range) age of 34+/-15 (16-65) years were recruited. Mean psychosocial questionnaire scores were: DAS24 45.5+/-17.8 (15-91); DLQI 7.5+/-6.7 (0-26). Participants had 1.9+/-1.5 (1-8) scars with an MSS score of 31.3+/-24.0 (6.6-162.0) and subjective score of 2.6+/-1.2 (0-4). Correlation between psychosocial distress and objective severity was not significant (DAS24 0.14 p=0.11; DLQI 0.16 p=0.06). Correlation between psychosocial distress and subjective severity was significant (DAS24 0.48 p<0.0001; DLQI 0.46 p<0.0001). Patients with non-visible scars experienced greater psychosocial distress than patients with visible scars (DAS24 9.7 p=0.046; DLQI 4.2 p=0.014). Scar type was unrelated to psychosocial distress. Patient-rated scar severity and scar visibility are correlated with 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 patient self-assessment should therefore form an integral part of clinical assessment.
authors.affiliation: Plastic & Reconstructive Surgery Research, Manchester Interdisciplinary Biocentre, The University of Manchester, Manchester M1 7DN, UK.
authors.forename: B C
authors.initials: BC
authors.lastname: Brown
authors.forename: T P
authors.initials: TP
authors.lastname: Moss
authors.forename: D A
authors.initials: DA
authors.lastname: McGrouther
authors.forename: A
authors.initials: A
authors.lastname: Bayat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001828:Body Image; D002921:Cicatrix / Q000209:etiology / Q000473:pathology* / Q000523:psychology*; D015331:Cohort Studies; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D011788:Quality of Life; D015203:Reproducibility of Results; D012649:Self Concept; D012720:Severity of Illness Index; D012867:Skin / Q000473:pathology*; D012880:Skin Pigmentation; D013315:Stress, Psychological / Q000453:epidemiology*; D055815:Young Adult