The psychosocial burden of skin disorders: a cross-sectional comparison of adolescents with diagnosed and undiagnosed skin disorders and skin-healthy controls

Adolescents with skin conditions often face profound psychosocial challenges that extend beyond physical symptoms. While prior research has focused on diagnosed cases, little is known about the impact on adolescents with undiagnosed skin concerns. This study aimed to compare quality of life and psychosocial outcomes across adolescents with diagnosed skin disorders, those with self-reported but undiagnosed skin concerns, and skin-healthy controls. We conducted a prospective, anonymized, questionnaire-based study involving 502 adolescents aged 14–18 at the University Hospital LMU Munich, comprising 117 with diagnosed skin disorders, 134 with self-reported but undiagnosed skin concerns, and 251 age-matched controls. All participants completed a detailed survey covering psychosocial domains; diagnosed and undiagnosed participants additionally completed the Dermatology Life Quality Index (DLQI). Both diagnosed (mean DLQI 6.1 ± 6.3) and undiagnosed (mean DLQI 6.0 ± 5.9) adolescents reported moderate impairment of quality of life, substantially exceeding the near-zero scores observed among the subset of controls who completed the DLQI (mean 0.12 ± 0.34; n = 32). Significant differences between skin concern groups and controls were observed in sleep (p < 0.001), participation in recreational activities (p = 0.013), discomfort in social settings (p < 0.001), and body image (p < 0.001). Notably, 34.2% of diagnosed adolescents reported poor understanding of their condition, compared to 67.9% of undiagnosed adolescents. Psychosocial burden was comparable between diagnosed and undiagnosed adolescents, suggesting that subjective distress rather than formal diagnosis is the primary determinant of psychosocial impact in this population.