Lichen simplex chronicus

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Lichen simplex chronicus
Lichen simplex chronicus - very low mag.jpg
Micrograph of lichen simplex chronicus. H&E stain.
Classification and external resources
Specialty dermatology
ICD-10 L28.0
ICD-9-CM 698.3
DiseasesDB 31441
MedlinePlus 000872
eMedicine derm/236
MeSH D009450

Lichen simplex chronicus (LSC) (also known as "Neurodermatitis"[1]) is a skin disorder characterized by chronic itching and scratching.[2] The constant scratching causes thick, leathery, darkened, (lichenified) skin. This condition is associated with many factors, including the scratch-itch cycle, psychological stressors, and atopy. LSC is more common between ages 35 and 50 and is seen approximately twice as often in women compared to men.[3]

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 exoriation.[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).[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 not necessary, and cannot be used to distinguish LSC from psoriasis.

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 lotions or steroid cream (such as triamcinolone or Betamethasone) applied to the affected area of the skin.[7] Nighttime scratching can be reduced with sedatives and antihistamines.[2] SSRIs can effectively reduce the scratching associated with obsessive psychosomatic behaviors.

Gallery[edit]

See also[edit]

References[edit]

  1. ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0. 
  2. ^ a b c d e f Lynch, Peter J. (2004-01-01). "Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital region". Dermatologic Therapy. 17 (1): 8–19. ISSN 1396-0296. PMID 14756886. 
  3. ^ a b c d e 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. 
  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. 
  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. 
  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. 
  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.