Lichen planus and itch-related psychosomatic disorders

BACKGROUND: The relevance of studying psychosomatic disorders associated with itching in patients with lichen planus (LP) is due to a wide range of transnosological comorbidity of nosogenic and depressive disorders with clinical phenotypes of LP.

AIMS: Clinical verification and typological differentiation of psychosomatic disorders associated with itching in accordance with the LP phenotypes we identified in patients of the studied sample.

MATERIALS AND METHODS: 120 patients (77 women and 43 men, average age 47.6±5.2 years) with various LP phenotypes and comorbid psychosomatic disorders associated with itching were examined. Dermatological, using the modern lichen planus area and severity index (LPASI); questionnaire of the severity of itching (behavioral rating scores, BRS), the dermatological quality of life index (DQLI) questionnaire; psychopathological, using the Hospital Anxiety and Depression Scale (HADS); clinical-psychological.

RESULTS: Psychosomatic disorders associated with itching were identified and typologically differentiated in patients with lichen planus: nosogenic reactions that develop in response to manifestations of a skin disease (depressive, sociophobic, beauty hypochondria), as well as recurrent depression. For each type of psychosomatic disorders, different ratios of dermatological and psychosomatic symptoms have been identified. Nosogenic reactions that develop within the considered ratios are comparable to nosogenies in severe somatic diseases and are clinically manifested by anxiety and depressive disorders. In other cases, the key trigger is not the severity of the dermatosis, as in nosogenic depression, but the cosmetically significant localization of the rash. These psychosomatic disorders are represented by sociophobic nosogenic reactions, as well as beauty hypochondria nosogenies, in the formation of which constitutionally determined somatoperceptual accentuations with deformation of the body image make a significant contribution.The role of constitutional factors and somatoperceptive accentuations is determined. The structure of amplified pruritus was analyzed, including the stressful impact of the SARS-CoV-2 pandemic. Methods of effective therapy based on an integrated interdisciplinary approach are presented.

CONCLUSION: Effective diagnosis and treatment of psychosomatic disorders associated with itching contribute to a significant optimization of the course of LP and improve the quality of life of patients.