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Abstract

Objective
This study aims to examine and understand the lived experience of remission in chronic skin disease (CSD). Emphasis has been paid to the psychological impact of living with CSD, but research has neglected the remission phase of the chronic relapse-remission cycle. Little is therefore known about how individuals experience episodes of skin clearance.

Methods
Interpretative phenomenological analysis (IPA) was used to analyse semi-structured interviews conducted with six participants discharged from a London-based NHS Psychodermatology service within the last five years. Three participants were diagnosed with atopic eczema, two with psoriasis and one with acne.

Results
Three major themes emerged from the interviews:

More than meets the eye: All participants spoke about a dissonance between visual and emotional symptoms in remission. Participants stressed that invisible psychological impacts of CSD pervade in remission. All participants spoke of the unseen suffering of side effects from physically effective
treatment.

All-consuming: Overwhelmed by fear and powerlessness: Participants described pervasive relapse anxiety, expressing a need to be “constantly on alert” to potential triggers in remission. Participants devised coping strategies to survive the sheer uncertainty of the relapse-remission cycle. Clinical power dynamics were also central to experiences of remission.

Alexithymic experience: While flares could be described in vivid detail, experiences of remission were universally more difficult to describe. Participants resorted to the language of comparison and negation in an attempt to access the opaque, sometimes forgotten, experience of remission.

Conclusions
Remission is an ill-defined but seemingly crucial psychological phase of the CSD relapseremission cycle. Unique psychological difficulties, such as ‘relapse anxiety’, may be present in remission and further research may consider the relevance of post-traumatic theory to these difficulties. Clinicians should be attuned to power dynamics and how they may discourage patients from voicing concerns in remission.

Publication Type:	Thesis (Doctoral)
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RL Dermatology
Departments:	School of Health & Psychological Sciences > Psychology School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses Doctoral Theses

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