Cutaneous body image in patients with lichen planus: A cross-sectional study

Abstract

Lichen planus (LP) poses a significant challenge due to its chronic inflammatory nature, profoundly affecting the quality of life (QoL) of those afflicted.¹ The present study sought to comprehensively evaluate the QoL in patients with LP, utilizing a multidimensional approach to capture the diverse facets of their lived experience. Consecutive patients with LP were recruited from the outpatient clinic of the Dermatology Department at a University Hospital in Greece between January 2021 and January 2024. Inclusion criteria comprised individuals aged 18 years and above, diagnosed with LP by a qualified dermatologist. Patients with comorbidities affecting QoL or those unable to complete the study questionnaires were excluded. Demographic and clinical data were collected from eligible participants, including age, gender, duration of LP, and disease severity based on the physician's global assessment of disease (PGA). The patient's disease severity was assessed using an 11-point numerical rating scale (NRS) from 0 to 10, with higher scores indicating greater severity. Additionally, participants self-reported the intensity of pruritus associated with LP using a similar 11-point NRS. Participants completed four validated self-administered questionnaires to assess various dimensions of QoL: Cutaneous body image scale (CBIS),^{2, 3} Dermatology Life Quality Index (DLQI),⁴ Skindex-16 ⁴ and EuroQol-5 Dimension-5 Level (EQ-5D-5L) and EQ-VAS.⁵

The CBIS rates mental perceptions of skin, hair, and nails on a 10-point scale, generating scores from 0 to 9, categorized as ‘severe’ CBI dissatisfaction for scores below 3, ‘moderate’ for 3 to 6, and ‘mild to none’ for scores above 6.^{2, 3} The DLQI, comprising 10 items, measures a skin condition's impact over the past week, scoring from 0 to 30, with higher scores indicating increasing impact on QoL.⁴ Higher scores indicate a greater impact on QoL: 0−1 means no effect, 2−5 a small effect, 6−10 a moderate effect, 11−20 a very large effect, and 21−30 an extremely large effect. The Skindex-16 evaluates skin disease impact through 16 items, divided into symptoms, feelings, and functioning, scoring from 0 to 100.⁴ The EQ-5D-5L assesses health across five dimensions, which are evaluated to determine the EQ-5D-5L index. This is done using a scoring algorithm based on a value set obtained from valuation tasks commonly conducted with samples from the general population. The EQ-5D-5L index ranges from −0.59 to 1, where one represents optimal health, and negative values indicate states worse than death.^{5, 6}

The data analysis utilized International Business Machines Statistical Product and Service Solutions Statistics version 25. Descriptive statistics summarized demographic characteristics, disease severity, pruritus intensity, and QoL scores. Correlation analysis examined the relationships between disease severity, pruritus intensity, and QoL measures. Statistical significance was set at p < 0.05.

Thirty patients diagnosed with LP participated in the study, comprising 30% (9/21) males and 70% (21/30) females. The mean age was 54.40 years (SD ± 14.05), with a mean disease duration of 8.37 years (SD ± 6.76). Demographic and clinical characteristics are described in Table 1. The mean CBIS was 5.70 (SD ± 1.46) with the majority of patients with LP experiencing moderate CBI dissatisfaction 18/30 (60%), as described in Table 2. The mean DLQI score was 7.83 (SD ± 4.71), indicating a moderate impairment in QoL. For the Skindex-16 questionnaire, participants reported a mean total score of 48.23 (SD ± 25.45). Subscale scores were as follows: symptoms 48.89 (SD ± 25.42), emotions 56.59 (SD ± 29.19), and functioning 48.23 (SD ± 25.45). The mean EQ-5D-5L index score was 0.74 (SD ± 0.29), with a mean EQ-Visual Analogue Scale (EQ-VAS) score of 72.33 (SD ± 19.10), see Table 2. Patient disease severity and pruritus intensity were found to be significantly correlated with the CBIS (p = 0.01), Skindex-16 total (p = 0.007), Skindex-16 symptoms (p = 0.011), Skindex-16 emotions (p = 0.011), and Skindex-16 functioning (p = 0.032), indicating a greater impairment in QoL with increasing disease severity.

To our knowledge, this is the first study to investigate the impact of LP on CBI. We found that the majority of patients with LP had moderate dissatisfaction with their CBI, which also had a moderate effect on their QoL. Larger studies are needed to validate further these results.

Dimitra Koumaki: Conceptualization data curation, writing—original draft preparation. Aikaterini Chatziperrou: Data collection, methodology. Stamatios Gregoriou: Conceptualization, supervision. Georgios Evangelou: Methodology, supervision. Aikaterini Doxastaki: Data curation, and data collection. Konstantinos Krasagakis: Supervision.

The authors declare no conflict of interest.

All patients in this manuscript have given written informed consent for participation in the study and the use of their deidentified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical Approval: Reviewed and approved by the Ethical committee of the University Hospital of Heraklion, Crete, Greece, IRB; approval 13742/10-10-2018.