Psychological Evaluation of Patients with Cutaneous Lichen Planus

Abstract

Background: Stress and anxiety have frequently been mentioned as possible factors related to the development of oral lichen planus (OLP). On the other hand, the psychological factors associated with cutaneous lichen planus (CLP) have only been insufficiently explored. A matched-pair, case-control study was conducted to perform a psychological evaluation of patients with a clinical and histological diagnosis of CLP with or without oral involvement. Patients and Methods: A consecutive, unselected series of 55 outpatients with CLP were examined. Stressful life events before disease onset, present or past psychiatric disorders, levels of anxiety and alexithymic traits were investigated. The impact of various life experiences was assessed by means of a self-report inventory. Alexithymia was evaluated by the Toronto Alexithymia Scale (TAS), and anxiety by the State and Trait Anxiety Inventory (STAI)-1 and STAI-2. The results then were compared to those obtained in a control series of the same number of patients with superficial fungal infections, matched for age and sex. Statistical analysis was performed by t and χ square tests. Results: No significant difference was found between the groups in respect to psychiatric disorders. 88.7% of patients versus 38.1% of controls reported to have experienced stressful events before onset of their disease. This difference was found to be statistically significant (p < 0.0001). However, the incubation period (the time between the stressful life event and the onset of disease) did not differ between the groups. Significantly greater mean scores for STAI-1 and STAI-2 were observed among patients with CLP than in the control group (p < 0.0001 and p < 0.05 respectively). With regard to the degree of alexithymia, even though the mean total score of TAS was slightly higher in the CLP group, there was no significant difference between the groups (p > 0.05). Conclusion: Patients with CLP had more often been exposed to stressful life situations before disease onset and suffered from anxiety significantly more often than controls. We suggest that CLP patients should be treated both dermatologically and psychologically.