Anogenital pruritus associated with depression and other psychiatric disorders

Emerging evidence suggests that anogenital pruritus is associated with anxiety, depression, and other mood disorders, and clinicians’ awareness of these findings may help enable comprehensive care for patients with anogenital pruritus.¹

The new findings come from a study written in part by Alex Balfour, BS, of the University of California, Irvine School of Medicine. Previous data has shown that chronic itch is commonly associated with reduced quality of life, psychological difficulties, anxiety, and depression.²

Moreover, Balfour and colleagues noted that the condition was associated not only with sexual dysfunction but also with experiences of stigma.³ Another study showed that anogenital psoriasis is one of the most difficult symptoms of genital psoriasis for patients to manage.^Four

“[Ano-genital pruritus]has been associated with experiences of discrimination and sexual dysfunction,” Balfour et al. write. “One study found that[anogenital pruritus]is one of the most common and debilitating symptoms of genital psoriasis. Here, we aimed to evaluate the association between[anogenital pruritus]and psychiatric disorders by conducting a population-level retrospective case-control study.”¹

Study Design and Conclusions

The research team conducted the study using TriNetX, a global health research network known to have data on over 100 million patients, and specifically focused on anogenital pruritus as their primary area of ​​interest.

Most of the people surveyed by the investigators were known to have been diagnosed with a depressive episode, major depressive disorder, or other anxiety disorder. The list of psychiatric disorders assessed by the investigators included examples such as major depressive disorder, depressive episode, and bipolar disorder.

The research team matched 1:1 with the control group for sex, age, and race/ethnicity and included individuals who underwent general adult screening and individuals with a diagnosis of psoriasis. Those who underwent general screening comprised a broad population with no major health concerns, but psoriasis patients were also included because of the known association between psoriasis and higher rates of psychiatric disorders.

A total of 286,109 subjects known to have anogenital pruritus and matched controls were included. The research team’s data showed that people with anogenital pruritus had a higher probability of psychiatric disorders compared with people with psoriasis and those who underwent general examination.

These conclusions suggest that there is an association between anogenital pruritus and certain psychiatric disorders, even when compared with patients with psoriasis, which is known to have a higher incidence of psychiatric disorders. Among psychiatric disorders, the highest odds ratios in both control groups were for persistent mood disorder, severe stress response and adjustment disorder, and unspecified mood disorder.

They noted that bipolar disorder was the second most common disorder identified by the researchers in the general testing group, and anxiety disorders were the second most common in the psoriasis group. The researchers also reported significant gender differences in the association between anogenital pruritus and the psychiatric disorders they assessed.

The researchers added that some limitations may need to be considered, such as the fact that the study is retrospective and that the team relied on ICD-10 codes, which may have led to misdiagnosis. Also, the underlying cause of anogenital pruritus was not identified, which may have an independent impact on the formation of psychiatric disorders.

“These findings highlight the importance of evaluating patients with skin diseases for the presence of[anogenital pruritus]and considering screening for psychiatric disorders when appropriate,” the researchers wrote. “Future studies are needed to better understand the incidence of[anogenital pruritus]in other skin diseases and to 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. Sexuality-related disorders and patient needs/benefits in anogenital psoriasis: a difficult topic to communicate and implications for patient-centered care. PLoS One 2020;15:e0235091.}
4. ^{da Silva N, Augustin M, Hilbring C, Braren-von Stülpnagel CC, Sommer R. Psychological (co)pathology in patients with psoriasis: The impact of pruritus and anogenital disorders on symptoms of depression, anxiety and body dysmorphic disorder – a cross-sectional study. BMJ Open 2022;12:e055477.}