(015) Vulvar Lichen Sclerosus is Associated with New Diagnoses of Mood Disorders
Authors: Choi U , Kohn T , Agrawal P , Clifton M 
Published: May 2023

Introduction

Vulvar lichen sclerosus (VLS) often presents with chronic pruritus. While VLS is associated with feelings of isolation, risk of mood disorders among females with VLS has yet to be quantified on a large scale.

Objective

Our objective was to assess the association of VLS with development of depressive episode, anxiety disorder, major depressive disorder (MDD), and prescription of antidepressants and benzodiazepines, and to evaluate the impact of VLS treatment.

Methods

A US claims database network (TriNetX Diamond Network) was queried from 2009 to 2022. Cohorts included women aged ≥18 with lichen sclerosus (LS) (ICD-10: L90.0) without prior diagnosis of MDD (F33), depressive episode (F32), or anxiety disorder (F40-F48) or previously prescribed antidepressants (VA: CN600) or benzodiazepines (CN302). We compared a control cohort of women with LS sparing the vulva with women with LS affecting the vulva (N90.4). We conducted a sub-analysis by age (18-40, 41-55, and &gt;55 years). We compared women aged ≥18 with VLS who received treatment (topical steroids (DE200), vaginal estrogen (GU500), prednisone (8640), hydroxyzine (5553), amitriptyline (704), gabapentin (25480), or tacrolimus (42316)) with women aged ≥18 with VLS who did not receive treatment within 6 months of VLS diagnosis. Finally, we compared women receiving only topical VLS treatment (topical steroids, vaginal estrogen, and tacrolimus) with those receiving no treatment. Outcomes of interest were depressive episodes, anxiety disorder, MDD or prescription of antidepressants or benzodiazepines within 6 months of VLS diagnosis. Propensity score matching was performed for age, ethnicity, race, type 1 diabetes (E10), vitiligo (L80), autoimmune thyroiditis (E06.3), alopecia areata (L63), pernicious anemia (D51.0), overweight and obesity (E66), type 2 diabetes (E11), hyperlipidemia (E78), essential hypertension (I10), and alcohol abuse (F10.10).

Results

124,237 patients had LS sparing the vulva and 16,676 had VLS. VLS was associated with increased risk of depressive episode (risk ratio (RR) [95% Confidence Interval] 1.62 [1.32-1.99]), anxiety disorder (RR 1.82 [1.50-2.22]), and MDD (RR 2.61 [1.69-4.03]) (Table 1) compared to LS sparing the vulva. Women with VLS were also more likely to receive antidepressants (RR 1.91 [1.60-2.29]) and benzodiazepines (RR 1.70 [1.44-2.01]). Among menopausal women, VLS was associated with increased risk of anxiety disorder (RR 2.00 [1.10-3.63]) (Table 2). Among postmenopausal women, VLS was associated with increased risk of depressive episode (RR 1.73 [1.38-2.17]), MDD (RR 2.60 [1.64-4.12]), anxiety disorder (RR 1.58 [1.29-1.94]), antidepressants (RR 1.55 [1.30-1.86]), and benzodiazepines (RR 1.48 [1.24-1.76]). Among women with VLS, VLS treatment was associated with decreased risk of depressive episode (RR 0.68 [0.47-0.98]) and increased risk of antidepressants (RR 2.00 [1.54-2.59]) and benzodiazepines (RR 1.70 [1.31-2.20]) compared to women without VLS treatment (Table 3). Stratifying by treatment type, women treated solely with topicals had numerically, but not significantly, lower risk of developing depressive episode (RR 0.73 [0.48-1.11]) compared to women without VLS treatment.

Conclusions

We demonstrate that women with VLS, compared to those with LS sparing the vulva, have an increased risk of antidepressant and benzodiazepine prescriptions and development of depressive episode, anxiety disorder, or MDD. Patients with VLS should be screened for these conditions, and VLS treatment should be considered.

Disclosure

No