Teaching empathy to undergraduate medical students using a temporary tattoo simulating psoriasis Lesley Latham, MSc, a Aimee MacDonald, BSc, b Alexa B. Kimball, MD, MPH, c and Richard G. Langley, MD, FRCPC a Halifax, Nova Scotia, Canada, and Boston, Massachusetts Background: Psoriasis has a profound negative effect on quality of life that is often underappreciated by health care professionals and the public. Objective: We sought to assess the perception of the burden of psoriasis relative to other medical conditions in first-year medical students, and to determine if wearing a temporary tattoo simulating psoriasis during a teaching exercise would change their perceptions. Methods: Participants completed a questionnaire assessing their perception of the impact of psoriasis and other common medical conditions (visual analog scale). Participants then wore a temporary tattoo of a psoriatic lesion for 24 hours and completed the same questionnaire after this exercise. Results: Of 91 students approached, 61 completed the study. At baseline, psoriasis (mean = 23.6) and eczema (mean = 23.3) were perceived as having the lowest physical burden of diseases queried (P \ .0001), whereas the mental impact of psoriasis was scored comparably with arthritis, heart disease, and diabetes (mean = 45.1-56.7), but lower than cancer (mean = 82.2) and depression (mean = 93.8). After the exercise, the perception of the impact of eczema (physical: mean = 37.3, P \ .0001; mental: mean = 66.6, P = .0005) and psoriasis (physical: mean = 37.8, P = .0014; mental: mean = 68.6, P = .0293) was significantly increased. Limitations: The exercise did not simulate the chronic nature of psoriasis or the scaling and pruritic characteristics of psoriatic lesions. The survey instrument used to assess empathy has not been previously validated and statistical analysis was limited by small sample size and the absence of a control group. Conclusions: Temporary tattoos are a novel and effective method of teaching medical students about the psychological burden of psoriasis. ( J Am Acad Dermatol 2012;67:93-9.) Key words: disease burden; empathy; medical education; morbidity; psoriasis; quality of life; skin disease. I t is becoming increasingly recognized that pso- riasis has a profound negative impact on mental and physical well-being. 1 Evidence suggests that patients with psoriasis experience a higher incidence of clinically significant psychiatric symptoms, such as depression and suicidal ideation, 2,3 compared with the general population. Furthermore, the burden of psoriasis is often underappreciated and poorly understood by the public which, in turn, contributes to stigmatization of these patients. 4-8 From the Division of Dermatology, Department of Medicine, a and Medical School, b Dalhousie University, Halifax; and Department of Dermatology, Clinical Unit for Research Trials in Skin, Massachusetts General Hospital, Harvard Medical School. c The first two authors contributed equally to this work. Dr Langley receives funding from the Canadian Dermatology Foundation for his research on melanoma. Conflicts of interest: None declared. Accepted for publication July 21, 2011. Reprint requests: Richard G. Langley, MD, FRCPC, Division of Dermatology, Dalhousie University, Room 4-195 Dickson Bldg, QE II Health Science Center, Halifax, Nova Scotia, Canada B3H 2Y9. E-mail: richardgblangley@gmail.com. Published online October 10, 2011. 0190-9622/$36.00 Ó 2011 by the American Academy of Dermatology, Inc. doi:10.1016/j.jaad.2011.07.023 Abbreviations used: SF-36: short form (36) health survey VAS: visual analog scale 93