Young people are commonly affected by skin problems and there is plenty of evidence that this can have a major impact on not just their teenage years but their whole life experiences. So, it is really important we try and get it right when we see them in dermatology.

It has been an honour to be part of many young patients’ journey into adulthood. Alongside this experience working with groups such as the eos youth panel has taught me so much about what works for young people. In Oxford we have a designated clinic for young people, with psychological support which has been shown to help experience and outcomes. However, good communication is something we can all do wherever we are seeing young people with skin problems.

It is pretty clear what patients want from us. My experience and research from young people with skin conditions shows two important requests from health-workers:

Give more information
Recognise the emotional impact of skin conditions

So how can this be done in a busy clinic?

You can do a lot in even a short consultation if you get the communication right: you can give information in a way that will be useful and provide the support and solutions young people need.

My top tips to use the time in clinic well:

RESPECT

The fact that they may have waited months or even years to be referred/get an appointment in dermatology. Take their time, skin and concerns seriously. This may be a small part of your busy day but it is likely a big deal in their life. Young people only seek help generally if they really want or need it and are likely to blame themselves for having ‘bad’ skin.

Call them the right name. Get this bit right and everything is more likely to go smoothly. When you call the patient ask if the name you have on their record is what they like to be called. They may want to be called a different name. They may identify as a different gender. This can get quickly picked up by just asking – ‘What do you like to be called?’.

ENGAGE with your patient

Offer to see them on their own. Ask if they want their parent or carer to come into the appointment with them or not. Explain you can catch up with others after the conversation if that works. If the parent/ carer does come in then make sure you communicate with the young person. Generally, parents want to help but they may need to be told to keep quiet.

ASK

Start with closed questions like: Where are you at school/ college? What are you studying? Closed questions are more likely to get you into a useful conversation than open ones such as ‘How are you feeling?’ This stuff can follow once you have got through a bit of talking. Ask about what has been going on with skin and ask the questions about impact on school, work, home, sleep and mood. BSPAD have developed a tool called ‘You and Your Skin’ which focuses on these and is a useful pre-clinic tool. Additionally, HEADSS is a useful clinic tool which can be downloaded as an app, filled in before clinic and used to aid consultation. Practice talking about things you may find embarrassing or awkward to talk about and it does get easier.

LISTEN

More than anything young people want to be listened too. They are people not just skin conditions. Often teenagers are stigmatised as being poor communicators but this is not my experience. If they are listened to, they will communicate, tell you what’s important to them and then you can work with them to help.

Consider IMPACT.

The emotional and psychological impact of skin problems is very important to young people. Do not dismiss this. Saying things like ‘it doesn’t look too bad’ won’t go down well if they feel bad about it. Patient-reported outcomes filled in before clinic can help guide you but ask the questions all the same: How is your skin affecting you? Is it stopping you do anything? Have you ever felt that life is not worth living or thought about harming yourself? If the emotional and psychological impact is disproportionate to the skin severity, then address this.

SUPPORT

There is a lot of support you can offer. Young people may benefit from referral to psychological service or may already have some psychological support. However, you can support them in relationship to their skin. Mostly just by being kind but also with specific advice. For example, supporting them to do things they may be avoiding – e.g. swimming or wearing clothes that show their skin. Thinking through what’s the worst that can happen can also help. Most of them will willingly accept that the most negative voice is their own and that addressing this can help them live their life.

Provide INFORMATION

Young people want solutions and accurate information. It is worth checking what they know already. As an example, I tend to ask the following for eczema: ‘You’ve lived with eczema so you know what that’s like – but what do you know about what it is and why the treatments are given? Do you want me to explain this?’. This doesn’t take long but can be a game-changer in terms of patient’s ability to manage their skin. They may have had years of various creams and ointment being prescribed and likely nobody has really explained why and how to use these.

Provide RESOURCES.

Providing links and resources should not be instead of explaining things but are a very useful addition. Have these available as a list or inserted into letters – telling someone ‘not to search the internet or go on social media’ is like telling people not to breathe. There is of course some unhelpful stuff available but some excellent resources too. These include the BAD Patient Hub, healthtalk.org, and other charities like Changing Faces, PSOteen, EOS, NES, BSPAD

DEMONSTRATION

Demonstrate topical treatments, or even better, work with a nurse who can do this brilliantly. Showing how is a better way to communicate than saying how. This can make a real difference to using treatments effectively and liberate them to be independent. The BAD has a range of videos on applying common treatments including how to apply emollients, wet wraps, or how to use topical steroids.

HONESTY

There are lots of very effective treatments for skin conditions, which is fantastic. However, many skin conditions do not have a ‘cure’ and many are chronic so need to be lived with to some degree. Avoid offering false hope and help support young people accept themselves and the skin they are in.

Managing young people is an honour and trying to get it right can have a real positive impact on this vulnerable yet vital and rewarding group of people.

About Dr Tess McPherson

Author of book for young people with facts on many skin conditions and includes a section on addressing emotional impact with many practical tips:

The Facts: Young Peoples Skin Conditions. A practical guide on how to comfortable in your skin.