Jeffrey Cohen, MD: Addressing Depression and Anxiety in Women with Lichen Sclerosis

A new investigation from the Yale School of Medicine explored the psychological implications of lichen sclerosus in American women, citing an increased risk of depression and anxiety among those affected by the condition.

The mental and psychological tolls associated with skin conditions such as lichen sclerosus have been prominent areas of research in the dermatology field. However, the conversations surrounding depression and anxiety related to lichen sclerosus continue to challenge and frustrate patients and providers alike.

In an interview with HCPLive, primary investigator Jeffrey Cohen, MD, from the Department of Dermatology at the Yale School of Medicine, spoke of how the findings from the study could help those affected by condition speak honestly about their struggles and find appropriate treatment.

Many women do not feel comfortable talking about this even with their doctors, and so this condition ends up going unrecognized (and) underdiagnosed, and is often diagnosed and picked up very late because people are hesitant to talk about it,” Cohen said. “To me, one of the most important things is bringing more awareness to this in terms of patients feeling comfortable talking to their doctors, and also bringing doctors to a place where they feel really comfortable talking about this, treating this, and evaluating this because it's something that's probably more common than we realized.”

For their study, Cohen and colleagues utilized data from the All of Us Research Program, a database which featured information on patients from underrepresented communities affected by lichen sclerosus, and determined that women affected by lichen sclerosus experienced a 2.16-fold and 2.5-fold increase in odds of depression or anxiety diagnoses, respectively.

Cohen stressed the need for proper diagnosis of lichen scherosus, especially considering how often it’s mistaken for other skin conditions. Porcelain white patches on the skin- usually in the genital area of the body- and skin atrophy are among 2 of the most common indications of the condition.

Naturally, the correct diagnosis can lead to the correct treatment, which can involve everything from frequent use of strong topical steroids to additional lubrication during intercourse.

Likewise, correctly diagnosing lichen sclerosus could also prevent the development of squamous cell carcinoma cancer of the female genitalia. Though rare, this form of cancer can develop in patients who are not appropriately treated.

“I think it is very important that we talk about the way that lichen sclerosis impacts several different facets of a patient's life so that they can be plugged into appropriate mental health care if needed,” Cohen said. And so that we can talk about certain lifestyle modifications and other ways that patients can try to improve their functionality despite having this condition.”

To hear more from Dr. Cohen on lichen sclerosus and how doctors and patients can be mental health advocates for this community, watch the full video interview above.