More than a skin disease: stress, depression, anxiety levels, and serum neurotrophins in lichen simplex chronicus

Abstract

Background Lichen simplex chronicus is a dermatological condition due to excessive scratching, with few studies on psychoneuroimmunology. Objective We aimed to estimate the levels of stress, depression, and anxiety, and to measure serum levels of neurotrophins in patients with lichen simplex chronicus, and to correlate these parameters with the severity of the disease and pruritus. Methods Thirty-six patients with lichen simplex chronicus and 36 age- and sex-matched healthy controls were included. Each participant was administered the Hospital Anxiety and Depression Scale and Perceived Stress Scale questionnaires, along with a visual analog scale for pruritus. Levels of neurotrophins (brain-derived neurotrophic factor, neurotrophin-3, nerve growth factor, glial cell line-derived neurotrophic factor) were determined by ELISA assays. Results The scores of Perceived Stress Scale-10, Hospital Anxiety and Depression Scale were statistically higher in patients (p < 0.05 for all). The serum levels of all neurotrophins were significantly lower in patients compared to healthy controls (p < 0.05 for all). Disease severity showed no correlation with all four neurotrophins. In linear regression models applied for increased visual analog scale-pruritus scores and disease severity these two variables were statistically significant predictors (p = 0.043). Study limitations A direct causal relationship was not addressed. Conclusion Lichen simplex chronicus patients are at risk of increased levels of stress, anxiety, depression, and present decreased levels of neurotrophins, that may suggest a role in the pathophysiology of this disorder.

Perceived stress in patients with inflammatory and non‐inflammatory skin conditions. An observational controlled study among 255 Norwegian dermatological outpatients

“…9 A recent study by Jusuf et al 26 confirmed the release of substance P in acne patients, but not in controls, while another study showed serum neurotrophins to be higher in lichen simplex compared with controls. 30 One study showed that patients with pigmented tumours experienced significantly lower stress compared with other skin conditions. 9 However, stress associated with non-inflammatory skin conditions is not previously explored, and the abovementioned biological mechanisms would not apply if no inflammation is present.…”

“…12,36,37 One dimension is related to perceived stress, another to coping ability and stress resilience. 29 In our study we used a simplistic approach and were interested in the general perceived stress using cut-offs as described by Cohen et al 12 and also used in other studies, 10 where values are considered: 'experiencing low stress' (0-13), 'moderate stress' (14-26) and 'high stress' (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). Individuals who did not give valid responses to all questions were excluded from calculations on perceived stress.…”

“… 26 confirmed the release of substance P in acne patients, but not in controls, while another study showed serum neurotrophins to be higher in lichen simplex compared with controls. 30 …”

Lichen Simplex Chronicus Itch: An Update

“…Several studies have demonstrated increased levels of the neurotrophins nerve growth factor (NGF) or brain-derived neurotrophic factor (BDNF) in atopic dermatitis and uraemic patients with pruritus ( 13 ). However, a recent study of 36 patients showed decreased levels of serum neurotrophin-3 (NT-3), NGF, glial cell line-derived neurotrophic factor (GDNF), and BDNF in patients with LSC compared with healthy controls, although levels were not correlated with disease severity ( 14 ). Another study of 33 patients with LSC demonstrated a significant reduction in intraepidermal nerve fibre density in sample tissue from the lesion site compared with a contralateral control site ( 15 ).…”

Acupuncture for neurodermatitis: a case report

“…2 Although neurodermatitis is not harmful, it can have a significant psychosocial impact on patients, causing depression, anxiety and sleep disruption. 3 As a result, it would be helpful to find a complementary or alternative therapy that is both safe and effective. Although acupuncture has the advantage of being simple and having few side effects, there is limited evidence to support its use in the treatment of neurodermatitis.…”