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(137) Psychopathological profile of patients with Lichen Simplex Chronicus, is there a therapeutic window?


Authors:

Maria Arteaga, MD – Fellow of CL- Psychiatry, Pontificia Universidad Católica de Chile

Jorge Carreño, n/a – Head CL-Psychiatry unit., Complejo Asistencial Barros Luco

Marianne Cottin, PhD(c) – Doctoral student, University of Chile

Pablo Toro, Dr. med – Head CL-Psychiatry unit. Associate Professor, Pontificia Universidad Católica de Chile

Abstract:

Background: Lichen Simplex Chronicus (LSC) is a chronic skin condition characterized by eczema caused by repeated and excessive scratching strongly  linked with  emotional factors. It mostly affects female patients, with a peak incidence between ages 35 and 50 years with an estimated prevalence between 2-12% (1-2). Treatment of LSC centers on the discontinuation of the itch-scratch cycle. Traditional therapies include topical corticosteroids, intralesional corticosteroids and antihistamines. A psychosocial approach is commonly used, but isn’t standardized.  

Objective: To describe the psychopathological profile of patients with LSC  before and after treatment with standard dermatological care along with a psychological intervention.


Methods: LSC outpatients and healthy volunteers were recruited from the university outpatients clinic. Psychiatric scales (pre/post intervention) were given, including the Symptom Checklist-90-Revised (SCL-90-R), State-Trait Anxiety Inventory (STAI) and NEO Five Factor Inventory (NEO-FFI).  All patients received standard dermatologic treatment and psychological intervention with behavioral therapy adapted from a program for trichotillomania (9 sessions). The study was approved by the ethics committee of the faculty of medicine at Pontificia Universidad Católica de Chile 


Results: 12 LSC patients (mean age= 46 years, 33% women) and 11 healthy volunteers (mean age= 46 years, 27% women) completed the study. Pre intervention: Hostility item of SCL-90 was significantly higher in the LSC compared to the control group (mean 0.42, SD=0.26 and 0.11, SD= 0.19 respectively: p < 0.01).  STAI: State Anxiety Scale (mean 41,66, SD= 27.05 and 19,36 SD=14.49; p< 0.05) and Trait Anxiety Scale (mean 33,16, SD=23.63 and 15.18, SD=12.38) were significantly higher in the LSC group as well. No differences were found in NEO-FFI. Post intervention: Results are being analysed statistically. 


Discussion: Higher levels of hostility and anxiety found in LSC patients is in concordance with previous reports (3). Despite the association of LSC and psychopathological traits, we found no studies focusing on specific social interventions (i.e. psychotherapy) for LSC patients.  It is necessary to complete the patients follow up to objectify the results of psychological intervention.

Conclusion/Implications: The psychopathological characterization of LSC patients  shows they are more hostile and anxious, therefore psychological interventions should be directed towards these traits.

References:  


  1. Lotti T, Buggiani G, Prignano F. Prurigo nodularis and lichen simplex chronicus. Dermatol Ther. febrero de 2008;21(1):42-6.

  2. Cleveland DEH. LICHEN SIMPLEX CHRONICUS. Can Med Assoc J. octubre de 1933;29(4):368-74. 

  3. Konuk, N., Koca, R., Atik, L., Muhtar, S., Atasoy, N., & Bostanci, B. (2007). Psychopathology, depression and dissociative experiences in patients with lichen simplex chronicus. General hospital psychiatry, 29(3), 232-235. 

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