Lichen simplex chronicus

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Lichen simplex chronicus
Other namesNeurodermatitis [1]
Lichen simplex chronicus - very low mag.jpg
Micrograph of lichen simplex chronicus. H&E stain.
Specialty Dermatology   OOjs UI icon edit-ltr-progressive.svg
Symptoms Thick leathery skin, exaggerated skin markings, small bumps, patches, scratch marks, scale [1]
Usual onsetGradual [1]
Causes Excessive rubbing and scratching [1]

Lichen simplex chronicus is thick leathery skin with exaggerated skin markings caused by sudden itching and excessive rubbing and scratching. [1] It generally results in small bumps, patches, scratch marks and scale. [1] It typically affects the neck, scalp, upper eyelids, ears, palms, soles, ankles, wrists, genital areas and bottom. [1] It often develops gradually and the scratching becomes a habit. [1]

Contents

Signs and symptoms

People burdened with LSC report pruritus, followed by uncontrollable scratching of the same body region, excessively. [2] Most common sites of LSC are the sides of the neck, the scalp, ankles, vulva, pubis, scrotum, and extensor sides of the forearms. [3] However, due to the stigma associated with chronic scratching, some patients will not admit to chronic rubbing or abrasion. The skin may become thickened and hyperpigmented (lichenified) as a direct result of chronic excoriation. [3] Typically this period of increased scratching is associated with stressors.

Causes

This is a skin disorder characterized by a self-perpetuating scratch-itch cycle: [4]

Many hypothesize LSC has a psychosomatic origin. [3] Those predisposed to itch as a response to emotional tensions may be more susceptible to the itch-scratch cycle. It may also be associated with nervousness, anxiety, depression, and other psychological disorders. [5] [6] Many people with LSC are aware of the scratching they do during the day, but they might not be aware of the scratching they do in their sleep. [2] LSC is also associated with atopy, or atopic dermatitis (eczema) and an increase of histamine levels. [2]

Diagnosis

LSC is typically diagnosed by careful observation and history taking. [3] It is easily recognized (see § Signs and symptoms and § Gallery). [2] Biopsies are sometimes necessary to confirm the diagnosis and differentiate it from other similar appearing lesions.

Treatment

Treatment is aimed at reducing itching and minimizing existing lesions because rubbing and scratching exacerbate LSC. The itching and inflammation may be treated with a lotion or steroid cream (such as triamcinolone or Betamethasone) applied to the affected area of the skin. [7] Night-time scratching can be reduced with sedatives and antihistamines. [2] Doxepin is often prescribed, as it offers both antihistamine properties and is also effective at reducing the (itch scratch cycle) associated with the obsessive psychosomatic behavioral symptoms.

See also

References

  1. 1 2 3 4 5 6 7 8 James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "4. Pruritus and neurocutaneous dermatoses". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Elsevier. pp. 53–54. ISBN   978-0-323-54753-6.
  2. 1 2 3 4 5 Lynch, Peter J. (2004-01-01). "Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital region". Dermatologic Therapy. 17 (1): 8–19. doi: 10.1111/j.1396-0296.2004.04002.x . ISSN   1396-0296. PMID   14756886. S2CID   22038447.
  3. 1 2 3 4 Lotti, Torello; Buggiani, Gionata; Prignano, Francesca (2008-01-01). "Prurigo nodularis and lichen simplex chronicus". Dermatologic Therapy. 21 (1): 42–46. doi:10.1111/j.1529-8019.2008.00168.x. ISSN   1529-8019. PMID   18318884. S2CID   41222102.
  4. Lee, Michael R.; Shumack, Stephen (2005-11-01). "Prurigo nodularis: a review". The Australasian Journal of Dermatology. 46 (4): 211–218, quiz 219–220. doi:10.1111/j.1440-0960.2005.00187.x. ISSN   0004-8380. PMID   16197418. S2CID   30087432.
  5. Konuk, Numan; Koca, Rafet; Atik, Levent; Muhtar, Sennur; Atasoy, Nuray; Bostanci, Bora (2007-05-01). "Psychopathology, depression and dissociative experiences in patients with lichen simplex chronicus" . General Hospital Psychiatry. 29 (3): 232–235. doi:10.1016/j.genhosppsych.2007.01.006. ISSN   0163-8343. PMID   17484940.
  6. Krishnan, Anjeli; Koo, John (2005-07-01). "Psyche, opioids, and itch: therapeutic consequences". Dermatologic Therapy. 18 (4): 314–322. doi: 10.1111/j.1529-8019.2005.00038.x . ISSN   1396-0296. PMID   16297003. S2CID   25983822.
  7. Yosipovitch, Gil; Bernhard, Jeffrey D. (2013-04-25). "Chronic Pruritus". New England Journal of Medicine. 368 (17): 1625–1634. doi:10.1056/NEJMcp1208814. ISSN   0028-4793. PMID   23614588. S2CID   1912215.