Smash: Perceived Stigma And Social Health In Patients With Chronic Skin Disease

Patients with visible skin conditions frequently endure perceived stigma and social rejection that significantly impacts their well-being. This two phase study evaluates the validity and utility of a new social health patient-reported outcome measure, StigMA & Social Health (SMASH), across five chronic skin diseases to understand its impact on patient’s well-being. SMASH is a 12-item survey with two subscales created from the validated Perceived Stigma Questionnaire (PSQ) and Social Comfort Questionnaire (SCQ). Scores ranged from 1 to 5 for each SMASH subscale, PSQ, and SCQ. Subjects (ages ≥13 years) diagnosed with atopic dermatitis (AD), psoriasis (PS), acne, cutaneous lupus (CL), or alopecia areata (AA) consented to the study. In Phase 1, subjects completed SMASH, PSQ, and SCQ at one visit. In Phase 2, subjects completed SMASH, Dermatology Life Quality Index (DLQI), and Patient Global Impression of Severity (PGIS) at two visits. All statistical analyses (correlations, Cronbach’s α, intraclass coefficient correlation (ICC)) were performed using JMP14. Phase 1 was completed by 50 subjects (AD=12; PS=12; acne=12; CL=7; AA=7). SMASH subscales exhibited strong internal consistency (Stigma α = 0.815; Social Health α = 0.855), similar to the PSQ and SCQ (α = 0.934 and 0.899). SMASH subscales strongly correlated with PSQ and SCQ across all diagnoses (r = 0.902 and 0.858; p<0.0001) and within diagnoses (r≥0.681; p<0.050). Acne subjects had the highest mean perceived stigma (2.51±0.73) and the lowest mean social comfort (3.41±0.85). A total of 92 subjects consented to Phase 2 (AD=20; PS=26; acne=26; CL=9; AA=11). We expect good test-retest reliability (ICC>0.700) for SMASH and strong correlation between patient-reported disease severity (r>0.700; p<0.05). We conclude that SMASH is a valid, reliable measure that captures the emotional burden of chronic skin disease. Utilization of SMASH in future studies would elucidate how social health is modified by treatment and disease course.