Cosmetic camouflage may improve QoL of pediatric patients with visible skin conditions

The use of cosmetic camouflage may aid in improving the quality of life (QoL) of pediatric patients who have visible vascular and pigmentary anomalies, according to a Canadian study published in the Journal of the American Academy of Dermatology (Nov. 2014; 71(5):935–940).

The study says researchers from the University of Montréal, was designed to quantitate the impact of visible skin conditions and the effect of cosmetic camouflage using the Children’s Dermatology Life Quality Index (CDLQI).

“[Through our research we were able to] quantify the benefit of cosmetic camouflage use in these patients who may experience a variety of negative reactions ranging from stares and avoidance to teasing and bullying,” said Dr. Michele Ramien, lead author who was a Pediatric Dermatology fellow when the study was completed and is now an assistant professor at the University of Ottawa and the Children’s Hospital of Eastern Ontario. The study was led and spearheaded by Dr. Danielle Marcoux, clinical associate professor at the University of Montréal. Dr. Marcoux is also a dermatologist at CHU Sainte-Justine in Montréal.

“The benefit of quantification is that it provides indisputable proof of a positive effect and may even help consideration for insurance/health care coverage of the camouflage products.”

Dr. Ramien said that this study validates an assumption maintained for a long time based on personal experience regarding the benefits of cosmetic camouflage for patients with visible skin conditions.

“I promote the use of cosmetic camouflage in my practice for patients who are bothered by the cosmesis of their skin condition, either as a temporary or permanent solution. I present it as an option that can be used for special occasions or on a daily basis if during my assessment and screening they endorse appearance-related distress,” Dr. Ramien said.

“I do not globally suggest cosmetic camouflage as there are many patients who are comfortable with their appearance and it cannot be assumed that anyone with a skin anomaly would want to cover it.”

Foundation colour matched to patient skin tone

“During the study assessment, we had trained a cosmetic specialist to teach pediatric patients and their parents how to apply makeup to their skin lesions that could not be camouflaged by clothing,” said Dr. Danielle Marcoux.

Each of the participants was given a sufficient amount of cosmetic product to allow for daily use for up to six months without charge. The investigators reported that foundation colour was matched to the patient’s skin-tone using the available palette of 28 shades.

“The most important part of cosmetic camouflage is the colour match to ensure natural looking coverage,” Dr. Ramien said.

“[In my practice], I usually suggest that they see a cosmetician to help them with this and try the product at home before using it for a special occasion [to avoid stress around the initial usage and so the child can get used to the feel and look of their cosmetic camouflage].”

Dr. Ramien added that the product they used during the study is sold at drugstores.

Cosmetic camouflage was well tolerated

A total of 41 children—four boys and 37 girls, ages five to 18 years—were recruited to participate in this study. The mean age of the participants was 13.6 + 0.6 years (range five to 18). The skin conditions included birthmarks, vitiligo and other skin irregularities.

Lead author Dr. Ramien, Dr. Marcoux and their colleagues reported that data was only analysed for 38 patients because two patients did not complete the study and a third patient did not properly complete the six month CDLQI questionnaire.

Findings revealed that baseline QoL scores revealed a small impact of vascular anomalies (CDLQI score 4.2) and a small to moderate effect of pigmentary anomalies (CDLQI score 6.1).

Similarly, six months after the intervention data showed that QoL improved in the study population as a whole (CDLQI score 5.1 versus 2.1, p<0.001), with significant improvement documented for facial lesions and vascular malformations. In all, cosmetic camouflage was found to be well tolerated and patients with pigmentary anomalies were more likely to continue using the products.

“Many of the patients were extremely satisfied with the results of cosmetic camouflage—the freeform part of our usage questionnaire had comments like ‘My daughter is a new person’ and ‘Thank you, this has changed my life!,’” Dr. Ramien said. She added that although some children adapt well to having a different appearance, others can be quite depressed and restrict their social circles.

“It was interesting to see that cosmetic camouflage had a positive impact on the lives of these pediatric patients and that effect was noted in their improved CDLQI scores,” Dr. Marcoux said. “Cosmetic camouflage allowed these individuals to feel more secure and more at ease among their peers and in the public.”

Interestingly, Dr. Marcoux noted that two of the children involved in the study had improved CDLQI even though they were not using the cosmetic camouflage. She added that these patients were just pleased to be informed about where they can access these types of makeup products. They were also pleased in general to be armed with the knowledge of how to use these products.

“These patients are happy to know that if they have an outing or an event to attend and they wanted to apply cosmetic camouflage, they could. That information gave them security,” Dr. Marcoux said.

The children who demonstrated the most improvement in their QoL were the ones who had facial lesions such as port wine stains and children with darker skin who had vitiligo, indicated Dr. Marcoux.

“Some visible skin conditions can be [medically] treated and that is helpful but sometimes treatment can be long,” said Dr. Marcoux. “I think the key message is that cosmetic camouflage can be used as a tool to help patients get through the period of time it takes for a treatment to work.”


Dr. Marcoux recommends that clinicians develop a network of cosmeticians who can assist these patients in finding the right makeup products for their skin type. In addition, she said that cosmeticians can also teach these patients how to properly apply cosmetic camouflage because this knowledge can make a difference in their QoL.

“Cosmetic camouflage benefits patients who need a protected window of time to accept or adapt to a new condition. It gives these children the ability to be seen and treated like anyone else, without the attention constantly being drawn to their skin anomaly,” said Dr. Ramien.

“Some of these children go on to accept their skin condition and no longer require cosmetic camouflage, while others can continue [with the cosmetic camouflage].”

Dr. Ramien reports that studies have also shown that [adjuncts] like cosmetic camouflage that increase patient satisfaction lead to better compliance overall with prescribed treatment and overall better outcomes.

“Given that there are really no adverse effects of cosmetics, I do not think there is a way you can ‘lose’ with using [this approach] as an adjunct for patients on active therapy or as primary treatment for untreatable conditions,” Dr. Ramien concluded.


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