The emotional burden of chronic skin disease dominates physical factors among women, adversely affecting quality of life and sexual function
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.
Section snippets
Methods
This cross-sectional controlled study was designed to investigate the QOL and female sexual function in a group of women suffering from CSD (group 1) and to compare their sexual function with that of a group of apparently healthy women (group 2 = control group).
The study protocol required all potentially eligible participants to provide histories (personal, medical, surgical, and sexual) and to undergo examinations (general, genital, and dermatological). Furthermore, all participants were asked
Data analyses
IBM SPSS software package version 20.0 (Armonk, NY: IBM Corp) was used for data analysis. Categorical data are described as numbers and percentages. The Kolmogorov-Smirnov test was used to verify the normality of the data distribution. Quantitative data are described as ranges, means, and standard deviations or medians.
For comparative studies, the chi-square test was used to analyze categorical variables, the t-test and ANOVA were used to analyze the normally distributed numeric data, and the
Results
According to the exclusion criteria, 79 potentially eligible participants were excluded from the study; 51 were women with CSD. Also, 53 eligible participants refused to participate; 30 were apparently healthy women. The mean age of the participants in group 1 was 37.31 ± 7.61 years, whereas the mean age of the participants in group 2 was 36.47 ± 6.84 years, with no significant difference between groups (P = .41). Regarding educational levels, group 1 included 29 illiterate participants, 27
Discussion
It is necessary to provide insight on the possible putative detrimental factors related to CSD that can have deleterious effects on patients' QOL and/or sexual function. This study aimed to answer the following question: which factor(s) is (are) more likely to influence QOL and/or sexual function among women suffering from CSD? The most likely putative factors to be considered were the physical factors and their associated emotional burden.
This study found that the DLQI score was significantly
Conclusion
The contribution of the emotional burden associated with CSD should not be overlooked as it dominates the physical effects of the diseases in adversely affecting the QOL and sexual function among women. It is necessary to provide this information to dermatologists, healthcare providers, and patients especially when effective cognitive behavior therapy has been shown to ameliorate the emotional stresses. Accordingly, it is possible to achieve a better QOL, especially among women presenting with
Acknowledgement
None.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of interest
The authors have no conflict of interest to declare.
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