Lichen simplex chronicus
| Lichen simplex chronicus | |
|---|---|
 |
|
| 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 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 the 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]
- ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
