A visible difference refers to a physical characteristic, such as a scar, mark, disfigurement, or condition on the face or body that distinguishes an individual from what is conventionally considered to be the societal norm. [1] These visible differences can arise due to a multitude of factors including but not limited to congenital conditions, accidents, diseases, or surgical procedures. Such differences often carry significant psychological, social, and sometimes physical implications for the affected individual. [2]
While the terms visible difference and disfigurement are sometimes used interchangeably, they are not synonymous and possess distinct connotations both in medical and social contexts. [3]
The term visible difference is a more neutral, encompassing descriptor for any physical characteristic that sets an individual apart from what is generally considered the societal norm. [4] This could be due to congenital conditions, acquired conditions, diseases, or even personal choices like tattoos or piercings. The critical element is that the difference is visible, but the term does not inherently imply any impairment, disadvantage, or negative valuation. [5]
Disfigurement is a term that has traditionally been used in both legal and medical contexts to refer to physical alterations that are often perceived as impairing the appearance of an individual in a significant way. [6] Disfigurement generally carries a more negative connotation and often implies a level of severity or permanence to the condition that may result in social, emotional, or functional difficulties for the affected individual.
The concept of visible differences has existed throughout human history, although the terminology and social attitudes have evolved. In many ancient cultures, visible differences were often attributed to supernatural causes or seen as a sign of divine intervention. [7] For example, birthmarks were sometimes viewed as omens or indicators of future events, both positive and negative. [8]
With the advent of modern medicine, understanding the causes behind various types of visible differences has become more scientific. In the 19th and early 20th centuries, significant strides were made in dermatology and plastic surgery, which allowed for a more nuanced comprehension and treatment of these conditions. [9] The latter half of the 20th century saw further research into the psychological and emotional impact of visible differences, paralleling the rise of psychology as a distinct scientific discipline. [10]
The latter part of the 20th century also saw the rise of activism aimed at destigmatizing visible differences and advocating for legal protections. [11] Landmark legislation, such as the Americans with Disabilities Act (ADA) in the United States and the Equality Act in the United Kingdom, have created legal protections for people with visible differences. [12] [13]
Changing Faces is a UK-based organization that advocates for people living with visible differences.
Visible differences can be categorized based on origin, location, and impact.
These are visible differences present from birth and are often the result of genetic factors or prenatal influences. [14]
These visible differences arise due to external factors, such as accidents or medical treatments. [15]
Certain diseases can cause visible differences either directly or as a side effect of treatment.
The presence of a visible difference can have profound psychological implications for an individual, affecting their self-esteem, mental health, and overall well-being. [19] Importantly, research has indicated that there is not a strong correlation between the visibility or severity of the physical characteristic and the level of psychological distress an individual might experience. This counterintuitive finding emphasizes the complexity of the emotional and psychological dimensions involved.
People with a visible difference often face self-esteem and body image challenges. [20] Concerns about appearance can dominate their self-perception, which may lead to feelings of inadequacy or unattractiveness. This can be particularly challenging during adolescence when physical appearance is often highly emphasized.
Studies have shown that individuals with visible differences are at a higher risk of developing anxiety disorders and depression. The constant awareness of being different and the fear of being judged or rejected can increase anxiety levels. Similarly, chronic feelings of isolation or stigmatization can lead to depressive symptoms.
The social implications of having a visible difference can sometimes lead to withdrawal or isolation. [19] Avoidance behavior, such as skipping social events or avoiding public places, can exacerbate feelings of loneliness and perpetuate a cycle of emotional distress. [20]
In some cases, individuals with a visible difference may develop body dysmorphic disorder, a mental health condition characterized by obsessive focus on perceived flaws in physical appearance. Importantly, these perceived flaws may be minor and not very noticeable to others. [21]
Individuals may employ various coping mechanisms, both adaptive and maladaptive, to deal with the psychological impact. While some may resort to avoidance or denial, others may seek social support or engage in constructive problem-solving. [22]
Contrary to common assumptions, the psychological distress associated with having a visible difference does not necessarily correlate with the visibility or severity of the condition. Factors such as personal resilience, availability of social support, and pre-existing mental health conditions often play a more significant role in determining the level of psychological impact. [2]
Acne also known as acne vulgaris, is a long-term skin condition that occurs when dead skin cells and oil from the skin clog hair follicles. Typical features of the condition include blackheads or whiteheads, pimples, oily skin, and possible scarring. It primarily affects skin with a relatively high number of oil glands, including the face, upper part of the chest, and back. The resulting appearance can lead to lack of confidence, anxiety, reduced self-esteem, and, in extreme cases, depression or thoughts of suicide.
A scar is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in some degree of scarring. An exception to this are animals with complete regeneration, which regrow tissue without scar formation.
Alopecia areata, also known as spot baldness, is a condition in which hair is lost from some or all areas of the body. It often results in a few bald spots on the scalp, each about the size of a coin. Psychological stress and illness are possible factors in bringing on alopecia areata in individuals at risk, but in most cases there is no obvious trigger. People are generally otherwise healthy. In a few cases, all the hair on the scalp is lost, or all body hair is lost. Hair loss can be permanent, or temporary.
A birthmark is a congenital, benign irregularity on the skin which is present at birth or appears shortly after birth—usually in the first month. Birthmarks can occur anywhere on the skin. They are caused by overgrowth of blood vessels, melanocytes, smooth muscle, fat, fibroblasts, or keratinocytes.
Disfigurement is the state of having one's appearance deeply and persistently harmed medically, such as from a disease, birth defect, or wound. General societal attitudes towards disfigurement have varied greatly across cultures and over time, with cultures possessing strong social stigma against it often causing psychological distress to disfigured individuals. Alternatively, many societies have regarded some forms of disfigurement in a medical, scientific context where someone having ill will against the disfigured is viewed as anathema. In various religious and spiritual contexts, disfigurement has been variously described as being a punishment from the divine for sin, as being caused by supernatural forces of hate and evil against the good and just, which will be later atoned for, or as being without explanation per se with people just having to endure.
A sebaceous gland or oil gland is a microscopic exocrine gland in the skin that opens into a hair follicle to secrete an oily or waxy matter, called sebum, which lubricates the hair and skin of mammals. In humans, sebaceous glands occur in the greatest number on the face and scalp, but also on all parts of the skin except the palms of the hands and soles of the feet. In the eyelids, meibomian glands, also called tarsal glands, are a type of sebaceous gland that secrete a special type of sebum into tears. Surrounding the female nipple, areolar glands are specialized sebaceous glands for lubricating the nipple. Fordyce spots are benign, visible, sebaceous glands found usually on the lips, gums and inner cheeks, and genitals.
Hidradenitis suppurativa (HS), sometimes known as acne inversa or Verneuil's disease, is a long-term dermatological condition characterized by the occurrence of inflamed and swollen lumps. These are typically painful and break open, releasing fluid or pus. The areas most commonly affected are the underarms, under the breasts, perineum, buttocks, and the groin. Scar tissue remains after healing. HS may significantly limit many everyday activities, for instance, walking, hugging, moving, and sitting down. Sitting disability may occur in patients with lesions in sacral, gluteal, perineal, femoral, groin or genital regions; and prolonged periods of sitting down can also worsen the condition of the skin of these patients.
Calcinosis cutis is an uncommon condition marked by calcium buildup in the skin and subcutaneous tissues. Calcinosis cutis can range in intensity from little nodules in one area of the body to huge, crippling lesions affecting a vast portion of the body. Five kinds of the condition are typically distinguished: calciphylaxis, idiopathic calcification, iatrogenic calcification, dystrophic calcification, and metastatic calcification.
Pseudofolliculitis barbae (PFB) is a type of irritant folliculitis that commonly affects people who have curly or coarse facial hair. It occurs when hair curls back into the skin after shaving, causing inflammation, redness, and bumps. This can lead to ingrown hairs, scarring, and skin discoloration. PFB can be treated with various methods, including changing shaving habits, using topical creams or ointments, and undergoing laser hair removal. Prevention measures include proper shaving techniques, using sharp razors, and avoiding too close a shave.
A comedo is a clogged hair follicle (pore) in the skin. Keratin combines with oil to block the follicle. A comedo can be open (blackhead) or closed by skin (whitehead) and occur with or without acne. The word "comedo" comes from the Latin comedere, meaning "to eat up", and was historically used to describe parasitic worms; in modern medical terminology, it is used to suggest the worm-like appearance of the expressed material.
A hamartoma is a mostly benign, local malformation of cells that resembles a neoplasm of local tissue but is usually due to an overgrowth of multiple aberrant cells, with a basis in a systemic genetic condition, rather than a growth descended from a single mutated cell (monoclonality), as would typically define a benign neoplasm/tumor. Despite this, many hamartomas are found to have clonal chromosomal aberrations that are acquired through somatic mutations, and on this basis the term hamartoma is sometimes considered synonymous with neoplasm. Hamartomas are by definition benign, slow-growing or self-limiting, though the underlying condition may still predispose the individual towards malignancies.
Acne fulminans is a severe form of the skin disease, acne, which can occur after unsuccessful treatment for another form of acne, acne conglobata. The condition is thought to be an immunologically induced disease in which elevated level of testosterone causes a rise in sebum and population of Cutibacterium acnes bacteria. The increase in the amount of C acnes or related antigens may trigger the immunologic reaction in some individuals and lead to an occurrence of acne fulminans. In addition to testosterone, isotretinoin may also precipitate acne fulminans, possibly related to highly increased levels of C acnes antigens in the patient's immune system. Acne fulminans is a rare disease. Over the past several years, fewer cases of this disease have occurred, possibly because of earlier and better treatment of acne. Approximately 100 patients with acne fulminans have been described.
Amelanotic melanoma is a type of skin cancer in which the cells do not make any melanin. They can be pink, red, purple or of normal skin color, and are therefore difficult to diagnose correctly. They can occur anywhere on the body, just as a typical melanoma can.
Cutis verticis gyrata is a medical condition usually associated with thickening of the scalp. The condition is identified by excessive thickening of the soft tissues of the scalp and characterized by ridges and furrows, which give the scalp a cerebriform appearance. Clinically, the ridges are hard and cannot be flattened on applying pressure. Patients show visible folds, ridges or creases on the surface of the top of the scalp. The number of folds can vary from two to roughly ten and they are typically soft and spongy. The condition typically affects the central and rear regions of the scalp, but sometimes can involve the entire scalp.
Madarosis is a condition that results in the loss of eyelashes, and sometimes eyebrows. The term "madarosis" is derived from the ancient Greek "madaros", meaning "bald". It originally was a disease of only losing eyelashes but it currently is the loss of both eyelashes and eyebrows. Eyebrows and eyelashes are both important in the prevention of bacteria and other foreign objects from entering the eye. A majority of patients with madarosis have leprosy, and it was reported that 76% of patients with varying types of leprosy had madarosis.
Pressure alopecia, also known as postoperative alopecia, and pressure-induced alopecia, occurs in adults after prolonged pressure on the scalp during general anesthesia, with the head fixed in one position, and may also occur in chronically ill persons after prolonged bed rest in one position that causes persistent pressure on one part of the scalp, all likely due to pressure-induced ischemia.
Osteoma cutis is a cutaneous condition characterized by the presence of bone within the skin in the absence of a preexisting or associated lesion. Osteoma cutis often manifests as solid, varying-sized, skin-colored subcutaneous nodules.
Sebaceoma, also known as a sebaceous epithelioma, is a cutaneous condition that appears as a yellow or orange papule.
Infantile acne is a form of acne that begins in very young children. Typical symptoms include inflammatory and noninflammatory lesions, papules and pustules most commonly present on the face. No cause of infantile acne has been established but it may be caused by increased sebaceous gland secretions due to elevated androgens, genetics and the fetal adrenal gland causing increased sebum production. Infantile acne can resolve by itself by age 1 or 2. However, treatment options include topical benzyl peroxide, topical retinoids and topical antibiotics in most cases.
Prison plastic surgery is plastic surgery or cosmetic surgery offered and performed to people who are incarcerated, as a means of social rehabilitation. These services were normally provided as part of a larger package of care that may include work training, psychological services, and more. Popular surgeries included rhinoplasties, blepharoplasty, facelifts, scar removal and tattoo removal. These programs began in the early 20th century and were commonplace up till the early 1990s. They took place across the US, the UK, Canada, and Mexico.