Acta Dermato-Venereologica 99-6CompleteContent | Page 14

564 CLINICAL REPORT Emotional Ability and Skin-restricted Lupus Evolution: A Longitudinal Study Isabelle JALENQUES 1# , Fabien RONDEPIERRE 2# , Aurélien MULLIEZ 3 , Michel D’INCAN 4 , Silla M. CONSOLI 5 and The LuPsy cohort investigators 1 Department of Adult Psychiatry and Medical Psychology, Clermont-Ferrand University Hospital, Clermont Auvergne University, 2 Department of Adult Psychiatry and Medical Psychology, 3 Department of Clinical Research and Innovation and 4 Department of Dermatology, Clermont- Ferrand University Hospital, Clermont Auvergne University, Clermont-Ferrand, and 5 Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France; AP-HP, West Paris University Hospitals, Department of Psychiatry, Paris, France # These authors contributed equally to this work. Impaired emotional abilities (higher scores of alexi­ thymia and lower levels of emotional awareness) were found in patients with skin-restricted lupus, warran- ting examination of the relationship between these abilities and the evolution of skin-restricted lupus, using longitudinal data. A total of 75 consecutive out- patients with skin-restricted lupus were recruited and assessed by a dermatologist and a psychiatrist every 6 months over a period of 2.5 years. Alexithymia and emotional awareness were evaluated with the French versions of the Toronto Alexithymia Scale (TAS-20) and the Levels of Emotional Awareness Scale (LEAS). During follow-up, good stability of the LEAS scores was observed, whereas TAS-20 scores varied; those varia- tions were positively associated both with lupus dura- tion and current psychiatric and personality disorders, but not with lupus remission. Such findings regarding 2 complementary aspects of emotional functioning are of direct interest for the management of patients with skin-restricted lupus. Key words: skin-restricted lupus; alexithymia (TAS-20); Levels of Emotional Awareness Scale (LEAS); psychiatric disorders; longitudinal study; emotional processing. Accepted Mar 4, 2019; E-published Mar 5, 2019 Acta Derm Venereol 2019; 99: 564–570. Corr: Isabelle Jalenques, Department of Adult Psychiatry and Medical Psychology, Clermont-Ferrand University Hospital, Clermont Auvergne University, 58 rue Montalembert, FR-63003 Clermont-Ferrand Cedex 1, France. E-mail: [email protected] P sychiatric and personality disorders have been re- ported recently among patients with skin-restricted lupus (SRL) i.e. discoid lupus erythematosus (DLE), lupus tumidus (LT) and subacute cutaneous lupus erythe- matosus (SCLE) (1–4), as reported among patients with systemic lupus erythematosus (SLE) or some chronic inflammatory skin diseases (5–10). Impaired emotional abilities have also been described: alexithymia, a difficulty in recognizing and communi- cating emotions, has been reported in SLE (11–15) and skin diseases (16–21); and lower emotional awareness (the capacity to represent, discriminate and elaborate both one’s own and others’ emotional experience in a given context) has been reported in patients with psoriasis doi: 10.2340/00015555-3161 Acta Derm Venereol 2019; 99: 564–570 SIGNIFICANCE Patients with skin-restricted lupus (SRL) have impai- red emotional abilities, i.e. higher alexithymia (inability to identify and describe emotions) and lower emotional aware­ness. This follow-up study investigated the relation- ship between emotional abilities and the evolution of SRL. The results showed no direct relationship between SRL re- mission and emotional abilities. Good stability of emotio- nal awareness scores was observed, whereas alexithymia scores varied; these variations were positively associated both with duration of lupus and the presence of current psychiatric and personality disorders. Such findings are of direct interest for the management of patients with SRL. who consider their disease to be stress reactive (18). We recently demonstrated, in a case-control study, that pa- tients with SRL had impaired emotional abilities (22), i.e. exhibited higher alexithymia scores and lower emotional awareness levels, than controls. Alexithymia scores, but not emotional awareness levels, were associated with concurrent psychiatric or personality disorders in patients with SRL: the case-control differences persisted after adjusting for such disorders, for emotional awareness levels, but not for alexithymia scores. In SLE, no significant correlation was observed bet- ween alexithymia and medical variables, in contrast to psychopathological symptoms, especially depression and anxiety (11, 13). In psoriasis, one study reported that alexithymia was associated with higher disease burden, including significant impairment of quality of life, higher levels of anxiety and depression, a higher risk of alcohol dependency and impairment of work productivity (19), while another did not find any association between alexithymia and psoriasis severity, but higher scores of alexithymia in the case of involvement of sensitive areas, such as the face, hands, and genital area (20). In addition, lower levels of emotional awareness predicted a better response to dermatological treatment in psoriasis (18). Given that our case-control study on SRL encompas- sed a longitudinal, prospective component, we decided to explore the relationship between emotional abilities and evolution of SRL. The objectives of this study were to assess, over a 2.5-year period: (i) SRL remission ac- This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.