Quality of life in lichen sclerosus: A psychodermatological study of clinical and psychological pathways

Lichen sclerosus (LS) is a chronic inflammatory dermatosis associated with significant quality of life (QoL) impairment. Despite growing attention to psychological distress in LS, its role within an integrated psychodermatological framework remains underexplored.

To investigate symptoms and psychosocial QoL impairment in LS patients and to identify sociodemographic, clinical, sensory, and psychological factors associated with worse outcomes.

This retrospective observational real-world study included 217 adults with genital LS attending a specialized LS Unit. Participants underwent an integrated dermatological and psychological assessment. Data included clinical variables, subjective sensory symptoms (burning, pruritus, dryness), emotional distress (anxiety and depression), and QoL (symptoms and psychosocial). Binary logistic regressions identified predictors of symptoms-related and psychosocial QoL impairment. Mediation analyses examined whether anxiety mediated associations between clinical variables and psychosocial QoL.

Symptoms-related QoL impairment was present in 36.4% of patients, while 20.9% showed impaired psychosocial QoL. Greater impairment was associated with female sex, longer diagnostic delay, higher sensory symptom intensity, sexual dysfunction, and increased anxiety and depression. In multivariate models, pruritus was the strongest predictor of symptoms-related QoL impairment. Psychosocial QoL impairment was associated with burning intensity and anxiety. Anxiety partially mediated the association between burning and psychosocial QoL impairment and fully mediated the relationship between disease relapse and psychosocial QoL impairment.

QoL impairment in LS reflects a close interaction between sensory symptoms and psychological distress, particularly anxiety. These findings support the clinical relevance of integrated psychodermatological assessment and highlight anxiety as a key psychosomatic process linking disease experience to psychosocial functioning.