Anogenital Pruritus Associated with Depression, Other Mental Health Disorders

Alex Balflour, BS

Credit: LinkedIn

New evidence suggests that anogenital pruritus has an association with anxiety, depression, and other mood disorders, and clinicians’ awareness of these findings may be helpful in allowing for comprehensive care for individuals with anogenital pruritus.¹

These new study findings resulted from research authored in part by Alex Balfour, BS, from the University of California, Irvine’s school of medicine. Prior data had indicated that chronic itch was connected to a generally diminished quality of life, psychological difficulties, anxiety, and depression.²

Additionally, Balfour and colleagues noted that this condition has also been linked to experiences of stigmatization as well as sexual dysfunction.³ Another piece of research indicated that anogenital psoriasis had been shown to be one of genital psoriasis’s most difficult symptoms to face among patients.⁴

“(Anogenital pruritus) has been associated with stigmatization experiences and sexual dysfunction,” Balfour et al. wrote. “One study found that (anogenital pruritus) is one of the most common and debilitating symptoms of genital psoriasis. Herein, we aimed to evaluate the association between (anogenital pruritus) and psychiatric disorders by performing a population-level retrospective case–control study.”¹

Trial Design and Conclusions

The research team conducted their study through the use of the global health research network TriNetX, a network known to have data on more than 100 million patients. The team set their sights specifically on anogenital pruritus as the main event of interest.

Most of the subjects included in the investigators’ searches had been shown to have diagnoses of depressive episodes, major depressive disorder, or other anxiety disorders. The list of psychiatric conditions evaluated by the investigators included such examples as major depressive disorders, depressive episodes, and bipolar disorders.

The research team matched the control arm 1:1 for sex, age, and race/ethnicity, including individuals who were given general adult examinations or individuals given a diagnosis of psoriasis. Although those provided a general examination made up a broad population without any major health concerns, individuals with psoriasis were involved due to the aforementioned known link between psoriasis and higher mental health disorder rates.

There were a total of 286,109 subjects who were known to have anogenital pruritus as well as an equal number of matched controls. The research team’s data indicated that those who had anogenital pruritus were shown to have increased odds of psychiatric conditions versus individuals with psoriasis or those given general examinations.

These conclusions showed that anogenital pruritus and certain psychiatric conditions had an association, and this was even the case when compared to those in the psoriasis arm already known for elevated rates of mental health issues. Among the psychiatric conditions, those with the highest odds ratios in both control arms were persistent mood disorders, severe stress reactions and adjustment disorders, and mood disorders which were unspecified.

The second highest identified by the investigators was bipolar disorder among those in the general examination arm, and anxiety was noted as the second highest among those included in the psoriasis arm. A major difference of gender was reported by the investigators as well within the link connecting anogenital pruritus and the psychiatric conditions evaluated by the team.

The investigators did add that several limitations may require consideration, such as the fact that the retrospective nature of the research and the team’s reliance on ICD-10 codes may have resulted in misdiagnoses. Also, the underlying causes of anogenital pruritus were not identified, and these could independently impact the formation of psychiatric conditions.

“These findings highlight the importance of evaluating patients with dermatologic conditions for (anogenital pruritus) and considering screening for psychiatric disorders as appropriate,” they wrote. “Future studies are necessary to better understand the incidence of (anogenital pruritus) in other skin conditions and evaluate additional factors that may contribute to psychiatric disorders in patients with (anogenital pruritus).”

References

1. ^{Balfour, Alex BS; Kraus, Christina MD. Anogenital pruritus is associated with anxiety, depression, and other psychiatric disorders. International Journal of Women’s Dermatology 10(3):p e168, October 2024. | DOI: 10.1097/JW9.0000000000000168.}
2. ^{Lee J, Suh H, Jung H, Park M, Ahn J. Association between chronic pruritus, depression, and insomnia: a cross-sectional study. JAAD Int 2021;3:54–60.}
3. ^{da Silva N, Augustin M, Langenbruch A, et al. Sex-related impairment and patient needs/benefits in anogenital psoriasis: difficult-to-communicate topics and their impact on patient-centred care. PLoS One 2020;15:e0235091.}
4. ^{da Silva N, Augustin M, Hilbring C, Braren-von Stülpnagel CC, Sommer R. Psychological (Co)morbidity in patients with psoriasis: the impact of pruritus and anogenital involvement on symptoms of depression and anxiety and on body dysmorphic concerns – a cross-sectional study. BMJ Open 2022;12:e055477.}