Psychopathological profile and quality of life of patients with oral lichen planus

Abstract Objectives Oral lichen planus (OLP) is a chronic, multifocal, sometimes painful, inflammatory disease of the oral mucosa. OLP can predispose development of psycho-emotional disorders. Until now, the relationship between the severity of lichen planus and the psychological profile of patients (psychological well-being, perceived stress and pain coping strategies) has never been studied. Material and Methods Study was conducted on 42 OLP patients. Number of sites involved, severity and activity score of OLP were evaluated. Psychological tests were used to evaluate patients’ psycho-emotional condition. The mean duration time of symptomatic OLP was 43 months. Results We detected that the longer the duration of subjective symptoms, the poorer the quality of life and the higher the level of perceived stress (PSS). Also, the higher the PSS results, the greater the anxiety and depression on Hospital Anxiety and Depression Scale (HADS). Likewise, higher level of depression in HADS was strongly correlated with worse quality of life. (p≤0.05). Conclusions In this study, we detected a relationship between duration of the disease, level of perceived stress and quality of life. The longer the disease lasts, the higher it tends to catastrophize. This may influence development or increase of the anxiety and depression and may decrease patients’ quality of life.


Introduction
Oral lichen planus (OLP) is a well-known and common chronic inflammatory disease of the oral mucosa.

Instruments
The following instruments were used to assess the different aspects of the patients' functionality: -Visual Analogue Scale (VAS) to assess the severity of pain and/or discomfort in the oral cavity using the self-assessed Visual Analogue Scale (VAS) 2,12 .

Study group characteristics
The patients in the study group were from 24 to 85 years old. The mean age was 59.6 (±12.44) years. There were 34 women (80.9%) and 8 men (19.1%) patients. All subjects were classified into categories depending on the presence of general comorbid diseases: "no diseases", "1 or 2 diseases", "3 or more diseases". Twelve subjects (28.6%) were found to have "no diseases", 19 patients (45.2%) had "1 or 2 diseases", and eleven (26.2%) had "3 or more diseases". The most frequent diseases were: hypertension, gastric and cardiovascular disorders.
All subjects that comprised the study sample were classified into categories "with subjective symptoms" of lichen planus (n=39, 92.9%), such as burning sensation or pain, or "without subjective There was a significant positive correlation between the VAS score and severity of OLP (r=0.32; p=0.04) and also a positive non-significant correlation between the VAS score and activity lesions score (r=0.26; p=0.09).
The psychological and psychopathological characteristics of the study group are presented in The correlation between sex, age, general health and quality of life The correlation analysis that examined the relationship between the patient's age and quality of life revealed a significantly worse quality of life in older patients on the subscale of positive well-being (r=-0.32; p=0.04). The patient's sex had no effect on the general well-being, perceived stress or coping strategies for pain. to use catastrophizing (r=0.32; p=0.04) as the coping strategy for dealing with pain. No correlation between the number of general diseases and other coping strategies for pain was observed.

The relationship between the severity of lichen planus and psychological factors
The correlation between the severity of lichen planus and psychological factors are shown in Table 2.   presented in Table 3.

Correlation between Anxiety, Depression (HADS) and other psychological factors
The correlations between anxiety, depression and other psychological factors are illustrated in Table 4.
Higher level of anxiety was significantly related to the use of catastrophizing (p=0.001) as a coping strategy for pain and worse quality of life in all measured domains. Likewise, higher level of depression was strongly correlated with worse quality of life in subscales assessing anxiety (p=0.000), positive wellbeing (p=0.000), self-control (p=0.001), general health (p=0.03), vitality (p=0.000) and general wellbeing (p=0.000).

Discussion
Studies on the etiology and pathogenesis of many somatic diseases suggest influence of multiple factors, including psychosocial ones, which have additive action. Based on that, lichen planus, whose etiopathogenesis is not fully known yet, is perceived as a psychosomatic disease 8,16 . Currently, an association between different oral mucosal diseases is being studied, including oral lichen planus lesions and psychiatric disorders, which have been studied more frequently over the past several years. Suresh,    and psychopathological profile of the patients were assessed. The mean age of OLP patients was 59.9 years, which is in accordance with observations that the disease occurs in adult patients between 40 and 70 years old. Women were 80% of the investigated patients. The predominance of this disease in women has also been noted in other studies 16 . In our study, the VAS score was positively and significantly correlated with the severity of OLP lesions; however, when the VAS score and the activity of lesions were rated, a significant correlation was not found. We can conclude that mainly the level of severity of the disease -and Although the main objective of the study was to assess psychopathological and psychological correlates of clinical characteristics in OLP patients, the limitations of this study must be pointed out, as the observational study design and lack of control group.
The results of our study confirmed the previous findings of other authors and suggest a need for additional therapeutic interventions, including psychological or psychiatric services for patients who have stress-induced oral diseases such as OLP 9 .
However, based on the obtained evidence, we can conclude that effective treatment of clinical stage of OLP will reduce their experience of pain, subjective discomfort and anxiety. It will eliminate one of the major stressors to which patients are exposed and reduce their chance to develop depressive symptoms and significantly improve their quality of life.