Are people looking at me? On appearance anxiety in atopic dermatitis

A conversation with a patient with atopic dermatitis in the clinic recently left me thinking.

Because atopic dermatitis tends to appear on the neck, the elbows, the knees, sometimes the face, the lesions can draw sidelong looks from passers-by, or unwanted “concern” from the people nearby.

A stranger’s unthinking glance can set off an enormous wave inside a patient — and it is almost always read in the worst possible light.

And because atopic dermatitis is a chronic condition, when it flares, the sense of not being fully in control of your own life leaves people anxious and unsettled for long stretches.

So patients may find themselves unconsciously avoiding eye contact, and reluctant to wear short sleeves or shorts, afraid of exposing the lesions.

Even after treatment, when the skin has clearly settled, the hurt inside often lasts much longer. It takes time to soothe.

Sadly, past pain — whether of the mind or the body — tends to lodge in the memory like a cut, a nightmare you cannot shake off.

None of this is easy.

In the clinic I sit with patients while they come to see their own situation clearly. We look at the photographs of the skin together, so as to understand what other people actually see when they look at us — rather than letting the imagination spread unchecked.

And I help patients learn to meet what the illness brings, in body and in mind: to know how to care for themselves, rather than endlessly chewing over the suffering the illness has already caused.

Whatever else, please accept the sadness, the anger and the anxiety you feel right now. There really have been a great many unhappy memories, and to have come this far is genuinely no small thing.

But do not forget either: the people who truly care about you do not mind a little scarring, a little flaking. What they care about is the whole of you. You are the light.

The world is not perfect, and there really are people who will deliberately tread on an old wound. Stay away from them. Do not give them the chance to hurt you.

Social platforms are largely built on telling you that you are not good enough — which is only to say they profit by trading on your insecurity.

You are precious. Please look after yourself, body and mind both. The scars will fade in the end. Give yourself time to recover, slowly.

Related

• More notes from the clinic
• Atopic dermatitis treated with classical formulas

Originally written in Chinese; this is a translation.