Lichen simplex chronicus
| Lichen simplex chronicus | |
|---|---|
| Other names | Neurodermatitis[1] |
 | |
| Micrograph of lichen simplex chronicus. H&E stain. | |
| Specialty | Dermatology  |
| Symptoms | Thick leathery skin, exaggerated skin markings, small bumps, patches, scratch marks, scale[1] |
| Usual onset | Gradual[1] |
| Causes | Excessive rubbing and scratching[1] |
Lichen simplex chronicus (LSC) 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]
Signs and symptoms
[edit]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
[edit]This is a skin disorder characterized by a self-perpetuating scratch-itch cycle:[4]
- It may begin with something that rubs, irritates, or scratches the skin, such as clothing.
- This causes the person to rub or scratch the affected area. Constant scratching causes the skin to thicken.
- The thickened skin itches, causing more scratching, causing more thickening.
- Affected area may spread rapidly through the rest of the body.
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
[edit]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
[edit]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.
Gallery
[edit]
See also
[edit]References
[edit]- ^ a b c d e f g h 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.
- ^ a b c d e 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.
- ^ a b c d 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.