International insights into bullying in patients with atopic dermatitis: Global trends and key predictors

Abstract

The World Health Organization has called for global action to reduce stigmatization in patients with skin conditions.1 Atopic dermatitis (AD) is commonly associated with perceived stigmatization.2, 3 The objective of our study was to identify the risk factors for bullying due to atopic dermatitis during childhood and adolescence. The survey was conducted within the framework of « Scars of Life », a cross-sectional observational study. Proportional quota sampling was used based on the distribution of the population according to age, sex, environment (large cities, towns and rural areas) and income, in order to guarantee national representativeness of the sample. Participants were asked whether they had a physician-confirmed diagnosis of atopic dermatitis. Table 1 presents the sample size for each country and for each group. The questionnaire was developed in collaboration with patient associations, as well as international AD experts. Participants were contacted by e-mail to complete a structured digital questionnaire. The questionnaire included socio-demographic characteristics and age of onset of AD. For patients with physician-confirmed AD, they were asked if, during their childhood or adulthood, they had ever (1) felt excluded or different from others, (2) been mocked in a mean way or (3) been a victim of violence. A ‘yes’ answer to any of these 3 questions was considered bullying. The project was reviewed by an ethics committee: IDRCB 2023-A02722-43. In total, there were 7840 individuals. Characteristics of patients and situations of bullying reported by individuals are described in Table 1. Black-African individuals reported significantly higher bullying rates than White individuals within African countries (32% vs. 17%, p < 0.001) and in non-African countries (31.6% vs. 18%, p < 0.001). However, Black-African patients experienced similar bullying rates whether they lived in countries where they were the racial majority or minority (p = 0.8). Therefore, Black-Africans have higher bullying rates than White individuals both inside and outside Africa. But their rates do not change depending on whether they are the majority or minority. In contrast, Asian individuals reported significantly more bullying in non-Asian countries compared to Asian-majority countries (33.4% vs. 19.3%, p < 0.001). Their bullying rates do change depending on context: much higher in countries where they are a minority compared to where they are the majority. Compared to young adults (18–35 years), older adults had a lower risk (Figure 1). Additionally, individuals with childhood-onset AD were at higher risk. While the timing of bullying was not assessed, it likely occurs mainly in school and social settings rather than in the workplace or other adult environments.4-7 The heightened bullying risk observed in Asia and the Middle East may reflect strong cultural beauty standards placing greater emphasis on clear skin, with increased peer rejection of individuals with visible skin conditions. Conversely, lower bullying risks in Australia and East Asia may indicate greater dermatological awareness, medical accessibility or social support structures that mitigate bullying behaviours. Finally, our findings suggest that in the context of AD, bullying transcends gender differences, affecting both sexes equally. Bullying in AD is driven by a complex interplay of age, ethnicity and geographical region rather than gender. Future research should explore how cultural perceptions of skin disease shape bullying behaviours and whether educational or policy-based interventions can mitigate these effects. Targeted anti-bullying strategies should address racial and cultural discrimination by promoting inclusivity through education, community engagement and strict enforcement of anti-bullying policies in schools and workplaces. Culturally tailored interventions and support systems for minority groups in non-majority settings are essential to reduce vulnerability and foster resilience. Study was designed by La Roche Posay Laboratoire Dermatologique, France. Ann'Laure Demessant-Flavigny, Caroline Le Floc'h, Nabil Kerrouche and Delphine Kerob are employees of La Roche Posay Laboratoire Dermatologique, France. Charles Taieb received fees from La Roche Posay Laboratoire Dermatologique, France, for setting up and overseeing this project. The other authors received fees for participating in the project's scientific committee [methodology validation, questionnaire development and manuscript writing]. The project was reviewed by a French ethics committee and was found to be in accordance with the ethical standards set forth by that committee. IDRCB 2023-A02722-43 [Committee for the Protection of Individuals South-East I dated 11 March 2024]. All individuals gave their consent for publishing their data. The datasets generated during and/or analysed during this study are available from the authors upon reasonable request.