Clinical Aspects of Itch in Lichen Planus

Lichen planus (LP) skin lesions are often accompanied by itch, but this symptom has not been thoroughly examined in LP. To better characterize itch in LP, 78 patients with LP were investigated. Itch was present in 94.9% of patients and was usually described as the most vexing symptom of LP. The mean?±?SD severity of itch according to visual analogue scale score was 6.9?±?2.8 points. Most patients experienced itching daily, pruritus episodes lasted longer than 1 min, and most often occurred in the evening. Itch was frequently described as burning and, for many patients, it was considered burdensome and annoying. The following factors most often increased the perceived severity of pruritus: sweating, high temperature, stress and hot water, while cold water and cold air often resulted in itch reduction. In conclusion, itch is the major subjective symptom of LP. Effective treatment of pruritus should be one of the main goals of LP therapy.

Quality of life assessment of patients with scalp dermatitis using the Italian version of the Scalpdex

The aim of this study was to assess quality of life in patients with scalp dermatitis using the Italian version of the Scalpdex, and to validate the instrument in Italian. The survey was conducted in outpatients with psoriasis, seborrhoeic dermatitis, alopecia, or follicular lichen. Data were completed on 194 patients, 78% of whom had psoriasis. Scalpdex scores were always higher in women than in men, and in younger people compared to elderly people. The most frequent items were: being ashamed, embarrassed, bleeding scalp, feeling self-conscious, bothered that the condition is incurable, having the choice of colour of clothes affected, having a negative effect on daily life. The Italian Scalpdex showed good internal consistency, test-retest reliability, convergent validity, and responsiveness. In conclusion, the Italian version of the Scalpdex is a useful instrument to measure quality of life in patients with a scalp condition.

Recognition and management of vulvar dermatologic conditions: lichen sclerosus, lichen planus, and lichen simplex chronicus

Lichen sclerosus, lichen planus, and lichen simplex chronicus are dermatologic conditions that can affect the vulva. Symptoms include vulvar itching, irritation, burning, and pain, which may be chronic or recurrent and can lead to significant physical discomfort and emotional distress that can affect mood and sexual relationships. With symptoms similar to common vaginal infections, women often seek care from gynecological providers and may be treated for vaginal infections without relief. Recognition and treatment of these vulvar conditions is important for symptom relief, sexual function, prevention of progressive vulvar scarring, and to provide surveillance for associated vulvar cancer. This article reviews these conditions including signs and symptoms, the process of evaluation, treatment, and follow-up, with attention to education and guidelines for vulvar care and hygiene.

Lichen ruber planus as a psychiatric problem

Our mouth is the mirror of our health and it might be said that numerous diseases which affect our organism may be manifested in the mouth. Early symptoms occurring within the oral cavity may emerge with diseases related to our blood system, gastrointestinal system, renal system, cardiovascular system, and mental system. They are manifested as a hyperkeratosis, which may have an erithematous background. What we talk about here is lichen ruber planus. Lichen ruber planus is a common chronic immunological inflammatory disease of mucosa and skin, whose manifestations vary from karatolytic to eritematous and ulcerating lesions. The most frequent psychogenic diseases which may lead to the emerging of lichen planus are depression, anxiety and stress. Depression is a condition of decreased psychophysical activity predominated by sadness, apathy and slowed-down pessimistic thinking. Anxiety is a complex feeling comprising anxiety, fear, tension and insecurity, and is accompanied by the activation of autonomic nervous system. Stress is a reaction to trauma, and it enhances survival.

Psychological health in patients with genital and oral erosive lichen planus

BACKGROUND

Erosive lichen planus is a severe, recurrent and recalcitrant disease that affects several mucosal areas, mostly the genital area and the mouth, but also, for example, the oesophagus and perianal area. The disease causes serious symptoms, because of the raw, de-epithelialized mucosa and healing with scars/adhesions, which affect the patient's life in many ways. It causes, for example, difficulties in eating, drinking and going to the bathroom. Treatment is complicated and, so far, few therapeutic drugs other than steroids have been reported.

OBJECTIVES

As the disease has severe implications on the patient's life it is important to investigate the psychological health of the patients, as well as the influence of stress on their health and wellbeing, in order to improve treatment. STUDY DESIGN, SUBJECTS AND METHODS: Forty-nine consecutive patients with erosive lichen planus were included during a 1-year period. The study was carried out as 'state-of-the-last-month', and stress, state anxiety, depression and 'erosive lichen planus factors', i.e. symptoms affecting daily life, were assessed.

RESULTS

Eighty-seven per cent of the patients had symptoms, severely affecting daily life. Unexpectedly, oral symptoms seemed to be the most prominent. Our results showed that depression, anxiety and stress were more common in patients with erosive lichen planus than in a control group.

DISCUSSION AND CONCLUSIONS

Erosive lichen planus is a severe disease with symptoms and complications affecting the patient's life. Our results indicate that their psychological health is also affected and emphasize the need for close collaboration between physicians, dentists with special knowledge in oral medicine and counsellors/psychologists to optimize handling of these patients.

Assessment of depression in subjects with psoriasis vulgaris and lichen planus

AIM

The aim of this study was to investigate the frequency of depressive symptoms in psoriasis vulgaris and lichen planus and to evaluate the relationship between the Beck depression scores and the Psoriasis Area and Severity Index (PASI) scores of subjects with psoriasis vulgaris.

SUBJECTS

The study involved 120 subjects attending the dermatology clinic of Izmir Ataturk Training Hospital (Izmir, Turkey) and comprised 50 subjects with psoriasis vulgaris, 30 with lichen planus and 40 healthy control subjects.

RESULTS

Subjects with psoriasis vulgaris, lichen planus and controls had depression scores of 58%, 53% and 20%, respectively. The Beck depression scores of patients with psoriasis vulgaris were significantly higher than those of the control group. The PASI scores showed a correlation with Beck depression scores. Smoking and drinking were very common in subjects with psoriasis vulgaris. There was no correlation between the duration of illness and depressive symptoms.

CONCLUSIONS

This study confirms the importance of depressive symptoms in two common dermatological diseases. It is important to recognize this association as it affects both clinical outlook and response to treatment.

Psychiatric disturbance in patients with oral lichen planus

The degree of mental disturbance in 56 patients with clinically and histologically verified oral lichen planus (OLP) and in 44 non-OLP patients was investigated by means of the Cornell Medical Index psychological questionnaire. A statistically significant difference in mental disturbance between OLP patients and non-OLP patients was found, the OLP patients being more disturbed (p less than 0.01). The mental health of the non-OLP patients was equal to that of the general Finnish population. Of the OLP patients, 48.2% were mentally healthy, 21.4% had a mild mental disturbance, 5.4% had a moderate mental disturbance, and 25.0% had a severe mental disorder. The corresponding figures for the non-OLP patients were 72.7%, 9.1%, 11.4%, and 6.8%. Of the 56 OLP patients, 21 were randomly selected and referred for a psychiatric consultation. Five patients refused the psychiatric interview. Of the sixteen patients who were examined, five had a moderate psychiatric disorder, seven had a mild psychiatric disorder, one had signs of neurosis, and three were mentally healthy. Most of the patients had the subjective feeling that the clinical appearance of OLP, including discomfort, became worse during times of mental stress. None of the patients, however, had a subjective feeling of mental disturbance; nor did any of them feel any need for psychiatric treatment, except in one case.

[Anxiety structure and catecholamine parameters in patients with rosacea, alopecia areata and lichen ruber planus]

90 patients suffering from selected dermatoses (rosacea, alopecia areata, lichen planus) underwent psychological tests of examination with special regard to verification of their anxiety structures. Urinalysis of catechol amine levels was simultaneously carried out in these patients. The test results proved a marked correlation between psychological factors and the activity of the adrenergic system. High level of activity, emotional unstableness, as well as tendencies to neurotic activities are connected with increased secretion of adrenaline and decreased secretion of noradrenaline++ and dopamine. The lability of catechol amine secretion (statistically significant variation above or below the physiological standard) is the cause of functional disorders.

Relation of stress and anxiety to oral lichen planus

Stress and anxiety have frequently been mentioned as possible factors related to the development of oral lichen planus, although this association appears to have only an anecdotal origin. In this study, 48 patients with a clinical and histologic diagnosis of oral lichen planus completed questionnaires aimed at assessing their stressful life events (Social Readjustment Rating Scale) and their tendency for anxiety (the trait portion of the State-Trait Anxiety Inventory). Age- and sex-matched control groups included patients who underwent biopsies for irritation fibroma and routine clinic patients. No significant differences were seen among any of the groups with respect to scores on the questionnaires. These results suggest that patients who manifest oral lichen planus have no greater tendency toward anxiety and no more stressful life events than other individuals.

[Psychosomatic aspects in patients with alopecia areata, rosacea and lichen ruber planus]

90 Patients suffering from alopecia areata, rosacea or lichen planus as well as 30 healthy persons at the age between 20 and 55 were psychologically examined. The findings reveal that the highest percentage of neuroses of the neurotic or psychasthenic type occurred in patients with rosacea (76.6% of the population). 91% of the patients with rosacea suspected a connection between the appearance of their cutaneous changes and stress situations. We conclude that psychogenic factors may be of great importance in the etiopathogenesis of rosacea.

[Anxiety as a state and anxiety as a personality trait in patients with alopecia areata, rosacea and lichen ruber planus]

Our study comprised the examination of 120 persons by psychological methods. Every 30 of them were patients with alopecia areata, rosacea, lichen ruber planus, and healthy skin. The results revealed that patients suffering from skin diseases may be characterized by different anxiety conditions. Patients with rosacea turned out to possess a high level of anxiety trait: accordingly, their reactions towards the disease showed a higher level of anxiety state than could be observed in alopecia areata or lichen ruber planus patients. With regard to rosacea etiopathogenesis, psychogenic factors seem to play a special part if compared to the other diseases. In most of the cases, traumatogenic situations preceded the appearance of dermatoses and aggravated their signs and symptoms.

A case study of pruritic eczema treated by relaxation and imagery

A 25-yr.-old white, married female was treated for chronic pruritic eczema through the use of frontalis EMG, relaxation, and imagery training. The biofeedback readings, ratings of the pruritus (0 to 5) and ratings of skin smoothness (0 to 5) were made over 10 sessions. Although the EMG measures did not decrease significantly, the rash disappeared completely. A 1-yr. follow-up confirmed disease control.

[Personality in patients with lichen ruber planus (author's transl)]

Psychological tests were performed in 26 woman and in 4 men (average age = 41,2 years) with the histopathological diagnosis of lichen ruber planus. The same tests were given to 30 healthy persons without functional and organic disturbances. Results obtained do not indicate the existence of any specific personality structure in people with lichen ruber planus. The examined persons revealed an autoaggression syndrome characterized by a sense of guilt, inclination for blaming others and suspiciousness. The patients with lichen ruber planus reveal a tendency to react with neurotic anxiety. In 86,6% out of the examined 30 patients with lichen ruber planus, psychical trauma preceded this skin disease. The factors obtained from patients with lichen ruber planus and from healthy people showed significant statistical differences.