Psychosocial and Socioeconomic Determinants of Stigma in Facial Localized Scleroderma

Facial localized scleroderma (LoS) often results in visible disfigurement and stigma, yet factors contributing to stigma in this population remain insufficiently characterized.

To identify clinical, psychosocial, and socioeconomic factors associated with stigma in patients with facial LoS.

A cross-sectional study was conducted between June 2023 and June 2025 at a tertiary dermatology and plastic surgery center in China. Patients aged ≥ 12 years with stable facial LoS completed validated questionnaires assessing appearance satisfaction (FACE-Q), social support (SSRS), and stigma (Stigma Scale for Chronic Illness). Clinical and socioeconomic data were collected, and multivariate regression was used to identify independent predictors of stigma.

Of 159 eligible patients, 123 completed the survey (mean age, 24.3 years; 66.7% female). Overall appearance satisfaction was low (FACE-Q mean, 47.8 ± 19.89). Higher stigma scores were independently associated with labial involvement, lower FACE-Q scores, and reduced social support. Lack of health insurance predicted greater intrinsic stigma, whereas residence outside first-tier cities was associated with higher extrinsic stigma. Disease severity (LoSDI) was not associated with stigma. Most patients reported limited awareness of reconstructive options, with dermatologists serving as the primary source of information.

Stigma in facial LoS is driven primarily by appearance dissatisfaction, inadequate social support, and socioeconomic disparities rather than clinical disease severity. These findings highlight stigma as a critical component of disease burden and support the need for multidisciplinary, patient-centered care integrating psychosocial support and improved access to reconstructive interventions.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.