Birthmark, scar, burn: I am different
Thomas touches his face. «My brownie belongs to me,» says the 14-year-old and smiles. «Brownie» is a nickname for the fist-sized birthmark that covers part of his left cheek and temple. Thomas was born with this nevus, Latin for birthmark. What would he do if Brownie were suddenly gone? «A part of myself would be gone - I don't want that,» he says resolutely.
Skin abnormalities can have various causes. They can be congenital, but can also be caused by illnesses and accidents. It is estimated that one in 500 children in Germany has a skin condition that affects their quality of life. Not every adolescent is as relaxed about their skin lesion as Thomas.
Large moles, port-wine stains, scars or burns attract the attention of others. This can be unpleasant for affected children and adolescents. Strangers of all ages stare, ask questions, want to touch, are disgusted. Parents cannot change this. But they can provide their children with targeted support to help them deal with their skin lesions in a confident and calm manner.
Comparisons are already made in kindergarten
Firstly, parents should know how their child is doing: how does the skin lesion affect their emotional and mental world? The conspicuousness has hardly any influence on the youngest children. «Toddlers don't really understand it yet,» says Ornella Masnari, psychotherapist at the University Children's Hospital Zurich and project manager of the Swiss «Hautstigma» initiative.
This changes in kindergarten and early school age, as this is when the first comparisons begin. «At this age, children realise that their skin lesions set them apart from their peers,» says Masnari.
This first perception of the skin abnormality is often still free of judgement, which changes dramatically in adolescence. During this phase, the identity of adolescents is formed. This also happens on the basis of their own appearance. «This makes teenagers with skin lesions vulnerable. They can feel uncomfortable in their own skin due to the dermatological peculiarity,» explains Masnari.
More decisive than the individual age, however, is the question of whether the child was born with the skin lesion. Children like Thomas, who have had the abnormality since birth, tend to perceive it more strongly as part of their own identity - and therefore accept it comparatively more easily. «It generally seems to be more difficult for young people whose skin lesions were caused by specific, possibly very sudden and traumatic events such as accidents and fires,» says the psychotherapist.
Those affected are stared at
The abnormality can also become a burden for a child if their environment reacts negatively to it - and this often seems to be the case in this country. Ornella Masnari interviewed both children and adolescents with facial skin lesions. The majority of them reported being stared at by those around them.
«Over 80 per cent stated that they experienced pity from others, 40 per cent that they were insulted with words and around a quarter that they were laughed at because of their skin abnormalities,» says the psychologist, who also surveyed 8 to 17-year-olds without skin abnormalities in another study. «These pupils rated their peers with skin lesions as less likeable, intelligent and popular,» says the researcher. Her study shows: Respondents were more likely to avoid them.
Parents should pay attention if the child avoids something
In general, people with skin lesions are at a disadvantage, be it when looking for a job or choosing a partner. However, the prejudices relate to first impressions - and can disappear if a person with a skin lesion appears competent or likeable. This is because in everyday interactions, more characteristics come into play than the birthmark or scar.
However, parents should not underestimate the social pressure on their offspring - and should be vigilant as to whether their child is suffering from the skin abnormality. For example, when there are big changes such as a change of school or moving house. «If the child starts to avoid what they basically like - swimming lessons, for example - then parents should take notice,» recommends Ornella Masnari.
If the child is missing out on their favourite activities as well as their friends, if they are spending less and less time with their peers, if they prefer to be alone for longer periods of time, parents should talk to their child about this and determine to what extent the skin lesion is the cause of the problem.
Professionals can support them in this: «We invite families to come in for an hour or two of counselling - this can be helpful for all family members,» says Masnari. At the same time, the psychotherapist emphasises: «Most children with skin lesions do not need long-term psychological support.»
Parents also have other ways of empowering their offspring. Firstly, they should never taboo the skin lesion. Instead, they can address the abnormality openly, positively and optimistically . This approach strengthens the child's self-esteem and resilience, because it shows them: My parents accept and love me as I am - there is nothing wrong with me, nothing wrong.
«Looks aren't important.» Such comments are well-intentioned. But they don't help.
«Looks aren't important.» Such comments are well-intentioned - but not enough. Because in everyday life, the adolescent is also surrounded by strangers who are only interested in their appearance and ask curious questions. «Parents can provide targeted help here by thinking with their son or daughter about how he or she mightrespond to these questions,» says Masnari.
She advises a three-point strategy: Firstly, the teenager can briefly explain the skin lesion to the stranger. Then it is important to reassure the stranger, for example: «The birthmark is not contagious» or «It doesn't hurt». And finally, Masnari recommends simply changing the subject.
Parents can rehearse these three reactions with their children. The role play may feel strange for the family at first. But in the end, it strengthens the child's social skills in dealing with both curious and tactless fellow human beings.
Strengthen the child's self-esteem in the long term
If the adolescent has mastered such an unpleasant situation positively in their everyday life, parents should praise them for it. In the long term, they can use these small successes in dialogue with the child as positive examples of how strong and self-confident they are. This approach also promotes the daughter's or son's self-esteem in the long term.
Parents can also educate their child's environment. «Mums and dads should talk to the teachers, for example, or give them written information - including what strategies they should use if other pupils or their parents ask questions or react negatively,» advises Ornella Masnari. For example, they can explain that it is just a birthmark and does not entail any restrictions.
What parents should not do? Pay too much attention to their child's skin lesion. For many mums and dads, this is particularly difficult. They may struggle with feelings of guilt because their child will have to cope with the abnormality for the rest of their lives. «However, it gets easier for the whole family over time,» reassures Masnari. This is because both the child and the parents grow with the challenge. And in the vast majority of cases, they master it brilliantly. Like Thomas with his brownie.
Further information: www.hautstigma.ch
What types of skin stigma are there?
Congenital skin lesions
Common congenital skin lesions include birthmarks and port-wine stains as well as haemangiomas. In Germany, port-wine stains occur in up to three out of every 1000 newborns. Girls are affected slightly more frequently. Up to 6 per cent of all newborns in Switzerland have birthmarks measuring up to 20 centimetres. These are considered small to medium-sized nevi. In contrast, so-called large nevi measure between 20 and 40 centimetres and are much rarer: in Switzerland, around four children are born with large nevi every year. Giant nevi are at least 40 centimetres in size and can occur anywhere on the body. However, they are even rarer than large nevi. Haemangiomas are very common: around 10 percent of all children in the first year of life are affected. More than half of all haemangiomas are located in the head and neck area.
Skin diseases
Neurodermatitis is the most common skin disease in children. It is a non-contagious, very itchy inflammatory reaction of the skin. Other skin diseases that can occur in childhood are psoriasis and vitiligo, in which white patches appear on the skin due to a loss of pigment cells.
Less common are so-called ectodermal dysplasias, a group of over 200 rare, genetic diseases of the skin, but also of the nails, hair and teeth. Their frequency is estimated at around 1:15,000. Epidermolysis bullosa in turn refers to a group of rare, genetic and congenital diseases that result in increased vulnerability of the skin. An estimated 100 to 150 sufferers live in Switzerland.
