How to Help Your Teen Navigate Atopic Dermatitis and Social Anxiety

Raising teens comes with its own set of challenges, especially when your child has atopic dermatitis. Living with a visible skin condition as a young person can often create unavoidable social stigma — leading them to feel more self-conscious during sports, embarrassed during social outings, or hesitant about dating.

As a parent, it’s important to encourage your teen to go out and participate in the world, something that can feel like an uphill battle during a flare. So how can you help them navigate this struggle to feel comfortable with their condition and accepted among their peers? It begins with understanding why social anxiety increases with atopic dermatitis, and how to help your teen through it.

Severe eczema is often misunderstood. During a flare, your teen may worry that classmates will think they are contagious or anticipate stares, questions, or negative reactions. “Teens with this skin condition can face bullying or experience anxiety because their physical appearance can be different,” says Liz Nissim, PhD, a clinical and school psychologist in Livingston, New Jersey. “They can spend some or a lot of their energy on trying to cover up the inflammation.”

Atopic dermatitis can also affect your teen’s self-esteem and social life. “This is the first time in their life that they are trying to find a community outside of their family,” says Kimberly Vered Shashoua, LCSW-S, at Vered Counseling. “It’s extremely important that they’re able to find people and connect with them.”

She notes that teens with severe eczema can feel as though they’ve been marked as “different,” which heavily impacts their self-esteem and may cause them to miss out on big events.

“Social milestones can be derailed when teenagers feel like they aren’t good enough to do certain things, such as feeling ‘too ugly’ to go to prom,” says Shashoua. “This can affect their willingness to participate in future events.”

Dr. Nissim adds that avoiding plans or meeting new people might result in teens not building the necessary social skills they’ll need for the future.“All of these experiences build their social skills, and their comfort in choosing friendships and ending ones that aren't working for them,” she says.

Nissim says these hurdles are further complicated with social media, where there’s an extreme emphasis on having flawless skin and certain “ideals” around body weight and shape.

While medication and treatment are essential for the management of eczema, emotional support and strong coping mechanisms can be vital for thriving with the condition. Here are a few ways you can help your teen feel more comfortable in their skin, even during a flare:

• Prepare a quick statement for questions. Teens with severe eczema will undoubtedly have times where they have to field questions about their condition. Parents and caregivers can help them prepare a small statement explaining what atopic dermatitis is so they can de-escalate the situation and dispel any myths off the bat.
• Help them understand that eczema is just one part of them. Make sure your teen understands that the appearance of their skin (especially during flares) is not a reflection of who they are. Highlight their strengths, interests, values, and the things that make them feel confident and capable.
• De-emphasize physical appearance. Shashoua encourages parents to help their teens figure out what they actually want out of life outside of physical appearance. Having honest, open dialogue with your teenager about how beauty is a social construct, and how what is considered beautiful often changes, can also be helpful.
• Consider therapy, if needed. For teens who are really struggling, Nissim recommends cognitive behavioral therapy. In her work, she sometimes uses mild exposure therapy, having teens put themselves in social situations for small bursts to practice one skill at a time. “These homework assignments can be effective in changing the thoughts and feelings that increase when joining social situations or talking to people,” she says.

• Teens living with atopic dermatitis may experience social anxiety, due to shame around the way their skin looks. This can lead them to skip out on important social events or milestones.
• It’s important to be honest with teens and help them understand that beauty is a social construct, and that their skin does not reflect their self worth.
• Teens may also benefit from cognitive behavioral therapy and even small bursts of exposure therapy to practice their skills and reduce their social anxiety.