Immunological aspects and quality of life among patients with lichen sclerosus

Lichen sclerosus (LS) is a chronic, inflammatory dermatosis that predominantly affects the anogenital region. The ethology of LS is currently regarded as multifactorial, encompassing genetic, autoimmune and tissue remodelling factors, as well as oxidative stress or urine occlusion. Clinical manifestations such as white plaques, atrophic skin, erythema, erosions or varying degrees of sclerosis substantially impair patients' quality of life. It has been indicated that individuals with LS frequently experience feelings of embarrassment, anxiety and social stigma, often resulting from the incorrect association of LS with sexually transmitted diseases. Moreover, the occurrence of sexual dysfunction in this group represents an important clinical concern: patients often refrain from sexual activity due to embarrassment caused by the appearance of the disease, as well as the discomfort associated with it. Recent research indicates that the diminished quality of life observed in patients with LS may arise not only from the direct physical manifestations of the disease, but also from the persistent inflammatory state associated with it. Proinflammatory cytokines, such as interleukin-1, interferon-γ and tumour necrosis factor-α, produced in excessive amounts may adversely influence neurotransmission, thereby contributing to a higher prevalence of psychiatric disorders among patients with LS. The impact appears to involve effects on the metabolism of dopamine, serotonin and noradrenaline. These mechanisms provide a basis for analysing the impact of biologic treatment on patients' mental health. This association highlights the potential for improving patients' outcomes, with regard to somatic symptoms and mental health, through the implementation of targeted anti-inflammatory therapeutic strategies.