Psycho-emotional profile of patients with vulvar lichen sclerosus

Aim: to assess the psycho-emotional profile in patients with vulvar lichen sclerosus.

Materials and methods. We examined 57 patients with a diagnosis of vulvar lichen sclerosus, the average age of 35.0 ± 0.6 (from 18 to 45) years. The control group included 45 healthy women without dystrophic changes in the external genital organs, who applied for a routine examination. The following methods were used to analyze the psycho-emotional profile: WAM questionnaire (well-being, activity, mood), Hospital Anxiety and Depression Scale (HADS), the Dermatology Life Quality Index (DLQI).

Results. In patients with vulvar lichen sclerosus a decrease in indicators “well-being” (24.3 ± 1.7 versus 52.4 ± 5.6 scores) and “mood” (28.7 ± 3.6 versus 58.1 ± 6.1 scores) was revealed; “activity” was changed slightly (41.2 ± 3.2 against 47.4 ± 4.9 scores). Depressive (75.4 % versus 15.6 %) and anxiety (68.4 % versus 20 %) disorders were also more common in this group. Significant deterioration in the quality of life in patients was confirmed by a DIQL (18.79 ± 4.98 scores).

Conclusion. Psycho-emotional profile of patients with vulvar lichen sclerosus is characterized by a change in most of the analyzed parameters. The presence of anxiety-depressive disorders can aggravate both the general somatic state and the course of the underlying disease. So activities aimed at improving the quality of life should be included in the rehabilitation of these patients.

1. Lewis F.M., Tatnall F.M., Velangi S.S. et al. British Association of Dermatologists guidelines for the management of lichen sclerosus. Br J Dermatol. 2018;178(4):839–53. DOI:10.1111/bjd.16241.

2. Pérez-López F.R., Vieira-Baptista P. Lichen sclerosus in women: a review. Climacteric. 2017;20(4):339–47. DOI: 10.1080/13697137.2017.1343295.

3. Bleeker M.C., Visser P.J., Overbeek L.I. et al. Lichen sclerosus: incidence and risk of vulvar squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev. 2016;25(8):1224–30. DOI: 10.1158/1055-9965.

4. Tran D.A., Tan X., Macri C.J. et al. Lichen sclerosus: An autoimmunopathogenic and genomic enigma with emerging genetic and immune targets. Int J Biol Sci. 2019;15(7):1429–39. DOI: 10.7150/ijbs.34613.

5. Major J., Brackenbury F., Gibbon K., Tomson N. The impact of vulval disease on patients’ quality of life. J Comm Nurs. 2016;30(2):40–4. Available at: https://www.jcn.co.uk/files/downloads/articles/50945-jcnapril-may-12-vulval-disease.pdf. [Accessed: 15.12.2019].

6. Schlosser B.J., Mirowski G.W. Lichen sclerosus and lichen planus in women and girls. Clin Obstet Gynecol. 2015;58(1):125–42. DOI: 10.1097/GRF.0000000000000090.

7. Felmingham C., Chan L., Doyle L.W., Veysey E. The Vulval Disease Quality of Life Index in women with vulval lichen sclerosus correlates with clinician and symptom scores. Australas J Dermatol. 2019 Nov 14. DOI: 10.1111/ajd.13197. [Epub ahead of print].

8. Lee A., Fischer G. Diagnosis and treatment of vulvar lichen sclerosus: an update for dermatologists. Am J Clin Dermatol. 2018;19(5):695– 706. DOI: 10.1007/s40257-018-0364-7.

9. Vettorazzi J., Valério E.G., Perez A.V. et al. The effects of lichen sclerosus and its treatments on sexuality: case report. Open J Obstet Gynecol. 2019;9(6):755–63. DOI: 10.4236/ojog.2019.96075.

10. Solopova A.G., Moskvichyova V.S., Blbulyan T.A., Makatsaria A.D. Restoration of sexual function in patients with kraurosis vulvae. [Vosstanovlenie seksual’noj funkcii u pacientok s kraurozom vul’vy]. Akusherstvo, ginekologiya i reprodukciya. 2019;13(1):63–9. (In Russ.). DOI: 10.17749/2313-7347.2019.13.1.063-069.

11. Yang M., Wen W., Chang J. Vulvar lichen sclerosus: A single-center retrospective study in China. J Dermatol. 2018;45(9):1101–4. DOI: 10.1111/1346-8138.14533.

12. Lawrance N., Yell J. Vulvar Pruritus. In: Vulvar Disease. Ed. J. Bornstein. Springer, Cham, 2019. 57–64. DOI: 10.1007/978-3-319-61621-6_7.

13. Doskin V.A., Lavrentieva N.A., Miroshnikov M.P., Sharay V.B. Test differentiated self-assessment of the functional state. [Test differencirovannoj samoocenki funkcional’nogo sostoyaniya]. Voprosy psihologii. 1973;19(6):141–5. (In Russ.).

14. Zigmond A.S., Snaith R.P. The hospital anxiety and depression scale. Acta Psychiatr Scand.1983;67(6):361–70. DOI: 10.1111/j.1600-0447.1983.tb09716.x.

15. Anderson R.T., Rajagopalan R. Development and validation of a quality of life instrument for cutaneous diseases. J Am Acad Dermatol. 1997;37(1):41–50. DOI: 10.1016/S0190-9622(97)70210-X.

16. Ignatovsky A.V., Agakishizade N.E. Vulvar scleroatrophic lichen and genitourinary syndrome: issues of diagnosis and treatment. [Skleroatroficheskij lihen vul’vy i genitourinarnyj sindrom: voprosy diagnostiki i lecheniya]. Medicinskij alfavit. 2019;1(7):39–41. (In Russ). DOI: 10.33667/2078-5631-2019-1-7(382)-39-41.

17. Zarochentseva N.V., Dzhidzhikhia L.K. Lichen sclerosus et atrophicus: modern view on the problem. [Skleroatroficheskij lihen vul’vy: sovremennyj vzglyad na problem]. Rossijskij vestnik akushera-ginekologa. 2018;18(6):41–50. (In Russ). DOI: 10.17116/rosakush20181806141.