Lichen simplex chronicus is a skin disease caused by chronic scratching, often as a result of conditions like atopic dermatitis. It presents as thickened, scaly skin and is treated with medication to control inflammation and itching. It can affect any area of the body and is typically treated with topical glucocorticoids and antihistamines.
Lichen simplex chronicus is a skin disease that results from chronic scratching. It may represent the final or final stage of skin conditions that cause severe, chronic itching or itching, such as atopic dermatitis. This skin disorder usually manifests itself as thickened skin with more prominence than normal skin marks, caused by long-term rubbing or scratching. Treatment involves stopping the itch-scratch cycle and giving medications that control inflammation and itching.
Also known as circumscribed neurodermatitis or circumscribed neurodermatitis, lichen simplex chronicus predominantly affects adults between the ages of 30 and 50. When this condition occurs as nodules, it is called prurigo nodularis. Lichen simplex chronicus has no predilection for sex. People who have atopic dermatitis, however, often suffer from the condition at an earlier age than non-atopic people.
Lichen simplex chronicus typically manifests as severe itching with roughening of the skin. Itching worsens in the presence of heat, perspiration, irritation from clothing, and psychological distress. Lichen simplex cronico got its name because its appearance resembles that of lichen on a tree. Typical skin lesions are erythematous, or red, raised, and scaly. Although its pathogenesis is not fully established, chronically repetitive rubbing or scratching trauma is hypothesized to induce a hyperplastic skin response.
On microscopic examination, the crests of the rete are elongated, and the papillary dermis contains fibrosis and lymphocytes. Marked epidermal thickening or acanthosis, increased keratin production or hyperkeratosis, and hypergranulosis occur. Interestingly, the microscopic lesions of lichen simplex chronicus look like normal skin on the palms and soles, but unlike the palms and soles, the lesions of lichen simplex chronicus have skin scarring. Common areas of involvement include the balls of the feet, ankles, back of the neck, and scalp. Women can experience this condition on the labia majora and men can experience it on the scrotum.
Treatment of lichen simplex chronicus involves the application of high-potency topical glucocorticoids with occlusion, such as betamethasone dipropionate or clobetasol dipropionate. Among patients who have intractable disease, injection of glucocorticoids at the actual lesions may be required. To control itching and prevent scratching, oral antihistamines such as hydroxyzine or tricyclic antidepressants with intrinsic antihistamine activity, such as doxepin, may be given. These antihistamine drugs usually lead to sedation or drowsiness, so people taking them should avoid activities that require full alertness, such as driving or operating heavy equipment. Additional medications, such as emollients, are used to prevent dryness, which can make itching worse.
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