Illness-related stigma mediates the association between disease severity and dermatology- specific quality of life in chronic inflammatory skin diseases: a structural equation modeling study

Background Chronic inflammatory skin diseases substantially impair health-related quality of life (HRQoL). However, clinical severity alone does not fully account for variability in patient-reported outcomes. Objectives To test a theory-driven pathway model linking disease severity to HRQoL via illness-related stigma and to examine the roles of hope and perceived social support. Methods In this single-center cross-sectional study ( n = 404), disease severity was assessed using affected body surface area (BSA), itch and skin pain. Illness-related stigma (8-item Stigma Scale for Chronic Illnesses, SSCI-8), hope (Herth Hope Index, HHI), perceived social support (Multidimensional Scale of Perceived Social Support, MSPSS) and HRQoL (Dermatology Life Quality Index, DLQI) were assessed using validated Chinese-language versions. Structural equation modeling with maximum likelihood estimation and bias-corrected bootstrapping (5,000 resamples) was performed. Results The model demonstrated good fit (χ 2 /df = 2.04; CFI = 0.977; TLI = 0.969; RMSEA = 0.051; SRMR = 0.058). Greater BSA (β = 0.30), itch (β = 0.20) and pain (β = 0.20) were associated with higher stigma (all P 0.001). Stigma was associated with lower hope (β = −0.53) and worse dermatology-specific HRQoL (higher DLQI scores; β = 0.44) (both P 0.001). Hope (β = −0.30, P 0.001) and perceived social support (β = −0.13, P = 0.007) were independently associated with better dermatology-specific HRQoL. The model accounted for 16.1% of the variance in stigma, 28.0% in hope, and 44.0% in dermatology-specific HRQoL. Conclusion Disease burden may influence HRQoL partly through illness-related stigma and reduced hope. These findings support integrating psychosocial assessment into routine dermatologic care.