Exploring the effects of visible atopic eczema on willingness for direct and indirect contact

Visible dermatological conditions are associated with stigma and social avoidance. Atopic eczema is a common, noncontagious skin disease that may affect visible areas such as the face and hands. Despite misconceptions regarding contagiousness, no previous research has systematically examined whether visible atopic eczema influences willingness for interpersonal contact.

To investigate whether the presence and severity of visible atopic eczema reduce willingness for direct and indirect contact, and to examine whether health anxiety, disgust propensity/sensitivity, COVID-19-related social withdrawal and perceived attractiveness predict willingness for contact.

Two experimental studies were conducted. In study 1 (n = 150), participants viewed images of a face or hand manipulated to display no, mild or severe atopic eczema. In study 2 (n = 168), a fully between-participants design was employed. Participants rated their willingness for direct contact and indirect contact, as well as perceived attractiveness. Measures of health anxiety, disgust propensity/sensitivity and the social impact of COVID-19 were also completed. Mixed and between--participants Anovas examined the effects of atopic eczema severity and stimulus type, and regression analyses assessed predictors of overall willingness for contact.

Across both studies, willingness for direct and indirect contact decreased significantly as atopic eczema severity increased (all P < 0.01). Participants were more willing to engage with individuals depicted with no eczema compared with mild eczema, and with mild compared with severe eczema. These effects were observed for both faces and hands and replicated across experimental designs. Perceived attractiveness was the strongest positive predictor of willingness for contact in both studies. Disgust propensity/sensitivity was a significant negative predictor in multivariate analyses, whereas health anxiety and COVID-19-related social withdrawal were not reliable predictors.

Visible atopic eczema significantly reduces willingness for both direct and indirect interpersonal contact, even at mild levels of severity. These findings are consistent with behavioural immune system accounts of disease-avoidance responses and suggest that stigma towards atopic eczema may be driven by perceptual and affective mechanisms. The results highlight the psychosocial burden associated with visible skin conditions and have implications for public education, stigma reduction and dermatological practice.