Quality of Life and Psychopathology in Lichen Planus: A Neglected Disease Burden

Authors

  • Zeno Fiocco Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9–11, DE-80337 Munich, Germany
  • Sophie Kupf
  • Leilah Patzak
  • Till Kämmerer
  • Teodora Pumnea
  • Lars E. French
  • Markus Reinholz

DOI:

https://doi.org/10.2340/actadv.v101.442

Keywords:

lichenoid eruptions, scalp dermatoses, depression, DLQI, psychodermatology

Abstract

The disease burden of lichen planus and its impact on patients’ quality of life have not been well studied. The aim of this mono-centre cross-sectional study was to investigate these factors. From June to September 2020, an anonymous survey was posted to 253 patients, who were diagnosed with lichen planus in our outpatient clinic from January 2018 to June 2020. Quality of life was evaluated using the Dermatology Life Quality Index (DLQI), the EuroQol 5-dimension 3-level score, and further quality of life indicators. Beck Depression Inventory II was used to evaluate symptoms of depression. A total of 100 patients completed and returned the survey. Lichen planus affected quality of life in 78% of cases. DLQI was higher for multiple localizations (r = 0.454, p < 0.001). Patients with genital lichen planus had a significantly higher DLQI (mean ± standard deviation (SD) 8.68 ± 6.96) than patients who were not affected in the genital area (5.01 ± 5.49; p = 0.009). DLQI was also significantly higher for ungual lichen planus (9.83 ± 7.6; not affected: 5.65 ± 5.84; p-value 0.039), and for cutaneous LP (mean 8.1, SD 6.22; not affected: 5.63 ± 6.12; p-value 0.045). Twenty-nine percent of patients had mild to moderate symptoms of depression, and 6% had severe symptoms of depression. Depression and reduced quality of life are an undetected and relevant burden affecting patients with lichen planus.

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References

Le Cleach L, Chosidow O. Clinical practice. Lichen planus. N Engl J Med 2012; 366: 723-732.

https://doi.org/10.1056/NEJMcp1103641 DOI: https://doi.org/10.1056/NEJMcp1103641

Browning J. Dermatology, Edited by Jean L. Bolognia Julie V. Schaffer Lorenzo Cerroni Fourth edition China: Elsevier, 2018, ISBN 978-0-7020-6275-9. Pediatric Dermatology 2018; 35: 289.

https://doi.org/10.1111/pde.13439 DOI: https://doi.org/10.1111/pde.13439

González-Moles MÁ, Warnakulasuriya S, González-Ruiz I, González-Ruiz L, Ayén Á, Lenouvel D, et al. Worldwide prevalence of oral lichen planus: A systematic review and meta-analysis. Oral Dis 2021; 27: 813-828.

https://doi.org/10.1111/odi.13323 DOI: https://doi.org/10.1111/odi.13323

Sawant NS, Vanjari NA, Khopkar U, Adulkar S. A study of depression and quality of life in patients of lichen planus. Scientific World Journal 2015; 2015: 817481.

https://doi.org/10.1155/2015/817481 DOI: https://doi.org/10.1155/2015/817481

Mansur AT, Kilic Z, Atalay F. Psychological evaluation of patients with cutaneous lichen planus. Dermatol Psychosomat 2004; 5: 132-136.

https://doi.org/10.1159/000081157 DOI: https://doi.org/10.1159/000081157

Dalgard FJ, Gieler U, Tomas-Aragones L, Lien L, Poot F, Jemec GBE, et al. The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol 2015; 135: 984-991.

https://doi.org/10.1038/jid.2014.530 DOI: https://doi.org/10.1038/jid.2014.530

López-Jornet P, Camacho-Alonso F. Quality of life in patients with oral lichen planus. J Eval Clin Pract 2010; 16: 111-113.

https://doi.org/10.1111/j.1365-2753.2009.01124.x DOI: https://doi.org/10.1111/j.1365-2753.2009.01124.x

Cheng H, Oakley A, Conaglen JV, Conaglen HM. Quality of life and sexual distress in women with erosive vulvovaginal lichen planus. J Low Genit Tract Dis 2017; 21: 145-149.

https://doi.org/10.1097/LGT.0000000000000282 DOI: https://doi.org/10.1097/LGT.0000000000000282

Radwan-Oczko M, Zwyrtek E, Owczarek JE, Szcześniak D. Psychopathological profile and quality of life of patients with oral lichen planus. J Appl Oral Sci 2018; 26: e20170146.

https://doi.org/10.1590/1678-7757-2017-0146 DOI: https://doi.org/10.1590/1678-7757-2017-0146

Rojo-Moreno J, Bagán J, Rojo-Moreno J, Donat JS, Milián MA, Jiménez Y. Psychologic factors and oral lichen planus: a psychometric evaluation of 100 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 86: 687-691.

https://doi.org/10.1016/S1079-2104(98)90205-0 DOI: https://doi.org/10.1016/S1079-2104(98)90205-0

Van Voorhees AS, Fried R. Depression and quality of life in psoriasis. Postgrad Med 2009; 121: 154-161.

https://doi.org/10.3810/pgm.2009.07.2040 DOI: https://doi.org/10.3810/pgm.2009.07.2040

Jafferany M, Patel A. Understanding psychocutaneous disease: psychosocial & psychoneuroimmunologic perspectives. Int J Dermatol 2020; 59: 8-15.

https://doi.org/10.1111/ijd.14629 DOI: https://doi.org/10.1111/ijd.14629

Ghosh S, Behere RV, Sharma P, Sreejayan K. Psychiatric evaluation in dermatology: an overview. Indian J Dermatol 2013; 58: 39-43.

https://doi.org/10.4103/0019-5154.105286 DOI: https://doi.org/10.4103/0019-5154.105286

Magin PJ, Pond CD, Smith WT, Watson AB, Goode SM. A cross-sectional study of psychological morbidity in patients with acne, psoriasis and atopic dermatitis in specialist dermatology and general practices. J Eur Acad Dermatol Venereol 2008; 22: 1435-1444.

https://doi.org/10.1111/j.1468-3083.2008.02890.x DOI: https://doi.org/10.1111/j.1468-3083.2008.02890.x

Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI) - a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19: 210-216.

https://doi.org/10.1111/j.1365-2230.1994.tb01167.x DOI: https://doi.org/10.1111/j.1365-2230.1994.tb01167.x

Group E. EQ-5D-3L. [accessed 18 April 2017] Available from: https://euroqol.org/eq-5d-instruments/eq-5d-3l-about/2017.

Smarr KL, Keefer AL. Measures of depression and depressive symptoms: Beck Depression Inventory-II (BDI-II), Center for Epidemiologic Studies Depression Scale (CES-D), Geriatric Depression Scale (GDS), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9). Arthritis Care Res (Hoboken) 2011; 63: S454-S566.

https://doi.org/10.1002/acr.20556 DOI: https://doi.org/10.1002/acr.20556

Eckstein PP. Angewandte Statistik mit SPSS: Praktische Einführung für Wirtschaftswissenschaftler. Springer Medizin Verlag, Heidelberg, 2006.

Field, Andy. 2013. Discovering Statistics Using IBM SPSS Statistics. 4th ed. London, England: SAGE Publications.

Eckey H-F, Türck M. Statistische Signifikanz (p-Wert). WiSt-Wirtschaftswissenschaftliches Studium 2006; 35: 415-418.

https://doi.org/10.15358/0340-1650-2006-7-415 DOI: https://doi.org/10.15358/0340-1650-2006-7-415

Lehmann EL. Consistency and unbiasedness of certain nonparametric tests. Ann Math Statist 1951; 22: 165-179.

https://doi.org/10.1214/aoms/1177729639 DOI: https://doi.org/10.1214/aoms/1177729639

Hedderich J, Sachs L. Angewandte Statistik. Springer-Verlag Berlin, Heidelberg, 2016 .

https://doi.org/10.1007/978-3-662-45691-0 DOI: https://doi.org/10.1007/978-3-662-45691-0

Fahrmeir L, Heumann C, Künstler R, Pigeot I, Tutz G. Statistik: Der weg zur datenanalyse. Springer-Verlag Berlin, Heidelberg, 2016 .

https://doi.org/10.1007/978-3-662-50372-0 DOI: https://doi.org/10.1007/978-3-662-50372-0

Bortz J, Lienert GA. Kurzgefasste Statistik für die klinische Forschung: Leitfaden für die verteilungsfreie Analyse kleiner Stichproben. Springer Medizin Verlag, Heidelberg, 2008.

Bender R, Lange S. Was ist der p-Wert? Deutsche Medizinische Wochenschrift 2001; 126: T39-T40.

https://doi.org/10.1055/s-2001-12739 DOI: https://doi.org/10.1055/s-2001-12739

Bland JM, Bland D. Statistics notes: one and two sided tests of significance. BMJ 1994; 309: 248.

https://doi.org/10.1136/bmj.309.6949.248 DOI: https://doi.org/10.1136/bmj.309.6949.248

Manolache L, Seceleanu-Petrescu D, Benea V. Lichen planus patients and stressful events. J Eur Acad Dermatol Venereol 2008; 22: 437-441.

https://doi.org/10.1111/j.1468-3083.2007.02458.x DOI: https://doi.org/10.1111/j.1468-3083.2007.02458.x

Picardi A, Amerio P, Baliva G, Barbieri C, Teofoli P, Bolli S, et al. Recognition of depressive and anxiety disorders in dermatological outpatients. Acta Derm Venereol 2004; 84: 213-217.

https://doi.org/10.1080/00015550410025264 DOI: https://doi.org/10.1080/00015550410025264

Picardi A, Abeni D. Stressful life events and skin diseases: disentangling evidence from myth. Psychother Psychosom 2001; 70: 118-136.

https://doi.org/10.1159/000056237 DOI: https://doi.org/10.1159/000056237

Allen CM, Beck FM, Rossie KM, Kaul TJ. Relation of stress and anxiety to oral lichen planus. Oral Surg Oral Med Oral Pathol 1986; 61: 44-46.

https://doi.org/10.1016/0030-4220(86)90201-X DOI: https://doi.org/10.1016/0030-4220(86)90201-X

Hong J, Koo B, Koo J. The psychosocial and occupational impact of chronic skin disease. Dermatol Ther 2008; 21: 54-59.

https://doi.org/10.1111/j.1529-8019.2008.00170.x DOI: https://doi.org/10.1111/j.1529-8019.2008.00170.x

Boehm D, Schmid-Ott G, Finkeldey F, John SM, Dwinger C, Werfel T, et al. Anxiety, depression and impaired health-related quality of life in patients with occupational hand eczema. Contact Dermatitis 2012; 67: 184-192.

https://doi.org/10.1111/j.1600-0536.2012.02062.x DOI: https://doi.org/10.1111/j.1600-0536.2012.02062.x

Dowlatshahi EA, Wakkee M, Arends LR, Nijsten T. The prevalence and odds of depressive symptoms and clinical depression in psoriasis patients: a systematic review and meta-analysis. J Invest Dermatol 2014; 134: 1542-1551.

https://doi.org/10.1038/jid.2013.508 DOI: https://doi.org/10.1038/jid.2013.508

Rapp SR, Feldman SR, Exum ML, Fleischer AB, Jr, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol 1999; 41: 401-407.

https://doi.org/10.1016/S0190-9622(99)70112-X DOI: https://doi.org/10.1016/S0190-9622(99)70112-X

Feldman SR. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol 2020; 82: 256-257.

https://doi.org/10.1016/j.jaad.2018.07.059 DOI: https://doi.org/10.1016/j.jaad.2018.07.059

Connor CJ. Management of the psychological comorbidities of dermatological conditions: practitioners' guidelines. Clin Cosmet Investig Dermatol 2017; 10: 117-132.

https://doi.org/10.2147/CCID.S111041 DOI: https://doi.org/10.2147/CCID.S111041

Finlay AY, Salek MS, Abeni D, Tomás-Aragonés L, van Cranenburgh OD, Evers AW, et al. Why quality of life measurement is important in dermatology clinical practice: an expert-based opinion statement by the EADV Task Force on Quality of Life. J Eur Acad Dermatol Venereol 2017; 31: 424-431.

https://doi.org/10.1111/jdv.13985 DOI: https://doi.org/10.1111/jdv.13985

Richards HL, Fortune DG, Weidmann A, Sweeney SKT, Griffiths CEM. Detection of psychological distress in patients with psoriasis: low consensus between dermatologist and patient. Br J Dermatol 2004; 151: 1227-1233.

https://doi.org/10.1111/j.1365-2133.2004.06221.x DOI: https://doi.org/10.1111/j.1365-2133.2004.06221.x

Donnarumma M, Fattore D, Greco V, Ferrillo M, Vastarella M, Chiodini P, et al. How to increase adherence and compliance in acne treatment? A combined strategy of SMS and visual instruction leaflet. Dermatology 2019; 235: 463-470.

https://doi.org/10.1159/000502575 DOI: https://doi.org/10.1159/000502575

Marasca C, Napolitano M, Monfrecola G, Masarà A, Annunziata MC, Donnarumma M, et al. Quality of life in people living with patients suffering from hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2020; 34: e342-34e3.

https://doi.org/10.1111/jdv.16319 DOI: https://doi.org/10.1111/jdv.16319

Osman OT, Mufaddel A, Almugaddam F, Augusterfer EF. The psychiatric aspects of skin disorders. Exp Rev Dermatol 2011; 6: 195-209.

https://doi.org/10.1586/edm.11.10 DOI: https://doi.org/10.1586/edm.11.10

Published

2021-12-14

How to Cite

Fiocco, Z., Kupf, S., Patzak, L., Kämmerer, T., Pumnea, T., French, L. E., & Reinholz, M. (2021). Quality of Life and Psychopathology in Lichen Planus: A Neglected Disease Burden. Acta Dermato-Venereologica, 101(12), adv00619. https://doi.org/10.2340/actadv.v101.442

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