By Dr Bourrel Bouttaz
One of the additional, painful aspects of all skin conditions is that they are accompanied by feelings of shame and guilt. These feelings affect both the patient and the parents. Children start to feel ashamed of their skin as they become more self-conscious about their appearance, around the age of six to seven.
There are many reasons for these very destructive feelings.
- Parents feel that they are responsible for the condition affecting their child, and yet atopic dermatitis is a condition affecting skin that is not sufficiently watertight. This is the consequence of the modern world, an urban lifestyle, the reduction in the number of infectious diseases, our modern diet, changes in the cutaneous and digestive flora, etc.
- Any visible, chronic illness can leave both patient and parents feeling powerless, unable to cope with the situation.
- At present, such conditions tend to be explained by focusing purely on the allergy or purely on the psychological aspect.
- Focusing purely on the allergy means that the offending allergen must be found. If it isn’t found, this is yet another reason to feel inadequate.
- Focusing purely on the psychological aspect means pointing the finger at the mother, who already feels anxious because she can’t find a solution.
Anxiety becomes a trap: the more the mother feels anxious, the more the child senses this, and the more stress hormones are released, causing eczema to flare up. It’s all about how the mother looks at her child. Skincare treatments will create a close bond between them, yet the child should also become more autonomous with age. Over time, the child thinks s/he is the cause of the anxiety affecting his/her mother and feels confused, making a link between the eczema and him/herself. This ambiguity can lead to separation anxiety, i.e. the child wants to cut the cord, but believes this will hurt the parents. Eczema can sometimes flare up as a result, and this can be seen particularly when children leave home to study elsewhere.
The trap closes even more tightly if emollient products continue to be applied by the parents once the child has become more self-conscious about their appearance. If the parents are still taking care of the child’s skin, the child cannot have the modesty s/he wishes – and yet this is essential to draw the line between what is allowed or not, what should be visible or not, private or not, intimate or not. When this line – symbolized by the skin – is not drawn, feelings of shame may begin.
- Avoid looking at the child’s skin with an expression of anxiety. Just look at the child with love. Don’t scrutinize the skin every day to see if there are any eczema patches. Talk about it as little as possible; just talk about everyday life, school, friends, homework, etc.
- Teach the child to apply his/her products at as young an age as possible. It doesn’t matter if it isn’t done perfectly.
- Attend consultations specifically for parents, to talk about problems without the child being present. Attention should also be given to caregivers, who need to be considered.
- Take part in therapeutic education sessions in relevant centers. These sessions enable participants to gain a better understanding of the condition and treatments. They also give them an opportunity to discuss the difficulties they encounter and talk with other patients, helping them to feel less alone and, above all, less guilty.