The emotional burden of chronic skin disease dominates physical factors among women, adversely affecting quality of life and sexual function

Highlights

• Chronic skin diseases impair women's quality of life (QOL) and sexual health (SH).

• Skin diseases can be confined to covered skin or involve emotionally charged regions.

• Involvement of the genitalia or exposed skin adversely impacts QOL and SH.

• The type of skin disease has no role in determining women's QOL and SH.

• Emotional factors play a key role in adversely affecting the QOL and SH.

Abstract

Background

Both physical and emotional effects are linked with the natural history of chronic skin diseases (CSD). Skin lesions can be confined to covered areas or involve emotionally charged regions (genitalia/exposed areas).

Objective

To investigate the contribution of the physical effects of CSD and their emotional burden in adversely affecting the quality of life (QOL) and sexual function.

Methods

Two groups were included: A group of women suffering from CSD and a control group. All participants answered the 19-item Female Sexual Function Index (FSFI) questionnaire. Women suffering from CSD answered the 10-item Dermatology Life Quality Index (DLQI) questionnaire; this group was divided into various subgroups according to the type of disease and regional involvement.

Results

Neither the DLQI score (P = .06) nor the FSFI scores were significantly affected by the type of disease. The DLQI score was significantly higher in the subgroups with involvement of genitalia or exposed areas (P: < 0.001and 0.01, respectively). Moreover, genital involvement was associated with pervasive and significantly lower FSFI scores, and the arousal, satisfaction, and total scores were significantly lower among women with the involvement of exposed areas. The DLQI score was significantly negatively correlated with the FSFI scores.

Conclusion

The emotional burden of CSD should not be overlooked as it dominates the physical effects of disease by adversely affecting QOL and sexual function among women. It is necessary to provide this information to dermatologists and patients, especially in light of effective cognitive-behavior therapy that can be undertaken to ameliorate the emotional stresses.

Introduction

Health/disease is determined by interactions between the mind, body, and the surrounding environment, and the skin is the interface between the body and the external world. Indeed, the skin clarifies how the physical and psychosocial factors interact and adversely affect the health [[1], [2], [3], [4], [5]].

Chronic skin diseases (CSD) vary greatly in their symptoms, signs, and distribution. For instance, lichen planus and lichen simplex chronicus cause intense itching, while psoriasis has mild symptoms, and vitiligo causes disfigurement.

The distribution of skin diseases also varies among patients. Skin lesions can be confined to covered areas of the body, but in some patients, skin diseases involve the emotionally charged regions (the genitalia or exposed areas). It has been established that CSD are associated with psychological distress [[1], [2], [3]], but the emotional status can still vary among patients according to involvement and distribution of skin disease on the genitalia or exposed areas. It has been found that patients often feel stigmatized and suffer from psychosocial strains because of visible lesions and reactions of fear and disgust from surrounding people [4,5].

The interactions between the mind and body involve a variety of biological systems and can result in deleterious effects on physical health, QOL, and sexual function. It has been established that chronic stress can induce physical effects, through neuroendocrine-immune communication, manifested by obvious changes in innate and adaptive immune responses [6]. In addition, the negative impact of urinary incontinence on women's QOL [7] and the significant improvement of sexual activity following repair of cystocele [8] is an example of how physical illness can negatively influence the patient's mind. The skin elucidates the reciprocal mind-body link; the chronic stress associated with psoriasis has been found to maintain and exacerbate the disease and some of its associated mental disorders [1].

King (2016) reported that depression is prevalent among patients with CSD, yet only 1% of these patients are screened for depression in the United States [9]. It is essential that physicians consider the influence of social and emotional strains associated with disease as this can aid in their management [[10], [11], [12]].

Several studies have already confirmed the negative impact of CSD on women's QOL and sexual function [[13], [14], [15], [16]]. Nevertheless, according to our knowledge, the influence of the physical effects of the various CSDs has not previously been investigated.

The aim of the present study was to investigate the contribution of the physical factors of CSD and their emotional burden in adversely affecting the QOL and sexual function of a group of women.