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{{Infobox_Disease |
  Name          = {{PAGENAME}} |
  Image          = |
  Caption        = |
  DiseasesDB    = 31441 |
  ICD10          = {{ICD10|L|28|0|l|20}}  |
  ICD9          = {{ICD9|698.3}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = 000872 |
  eMedicineSubj  = derm |
  eMedicineTopic = 236 |
  MeshID        = |
}}
{{SI}}
}
__NOTOC__
__NOTOC__
{{CMG}}; {{AE}} {{KS}}


==Overview==
{{CMG}}; {{AE}} {{KRP}}


'''Lichen simplex chronicus''' (LSC) is a [[skin]] disorder characterized by chronic itching and scratching. The constant scratching causes thick, leathery, brownish skin.
{{SK}} Neurodermatitis, neurodermatitides, circumscribed neurodermatitis, circumscribed neurodermatitides, localized neurodermatitis, localized neurodermatitides
{{SI}}


==Causes==
==Overview==


This is a skin disorder characterized by a self-perpetuating scratch-itch cycle:
Lichen simplex chronicus (LSC) is a [[Chronic (medical)|chronic]] skin condition associated with a persistent itch-scratch cycle, leading to a thick, leathery, dark ([[Lichenification|lichenified)]] skin. Similar to many other skin conditions, it may present with associated dryness, scaling, or [[erythema]]. Commonly affected regions include neck, ankles, [[Limb (anatomy)|extremities]], [[scalp]] and [[Sex organ|genital]] region. The incidence and prevalence of the condition are not well established, but this is observed to be more common in adult female patients. The [[pathophysiology]] remains unclear, but it's thought to arise from disturbances between central and peripheral [[Nervous tissue|neural tissue]] in the perception of itch, causing that persistent itch-scratch cycle. Several psychological disturbances like anxiety and depression have been associated with this [[Dermatological lesions|dermatological]] condition.
==Pathophysiology==


*It may begin with something that rubs, irritates, or scratches the skin, such as clothing.  
*LSC develops over the regions which are accessible to scratching.<ref name="JuarezKwatra2020">{{cite journal|last1=Juarez|first1=Michelle C.|last2=Kwatra|first2=Shawn G.|title=A systematic review of evidence based treatments for lichen simplex chronicus|journal=Journal of Dermatological Treatment|year=2020|pages=1–9|issn=0954-6634|doi=10.1080/09546634.2019.1708856}}</ref><ref name="BoozalisTang2018">{{cite journal|last1=Boozalis|first1=Emily|last2=Tang|first2=Olive|last3=Patel|first3=Shivani|last4=Semenov|first4=Yevgeniy R.|last5=Pereira|first5=Manuel P.|last6=Stander|first6=Sonja|last7=Kang|first7=Sewon|last8=Kwatra|first8=Shawn G.|title=Ethnic differences and comorbidities of 909 prurigo nodularis patients|journal=Journal of the American Academy of Dermatology|volume=79|issue=4|year=2018|pages=714–719.e3|issn=01909622|doi=10.1016/j.jaad.2018.04.047}}</ref><ref name="pmid31569651">{{cite journal| author=Whang KA, Khanna R, Thomas J, Aguh C, Kwatra SG| title=Racial and Gender Differences in the Presentation of Pruritus. | journal=Medicines (Basel) | year= 2019 | volume= 6 | issue= 4 | pages=  | pmid=31569651 | doi=10.3390/medicines6040098 | pmc=6963580 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31569651  }}</ref><ref name="HuangCanner2020">{{cite journal|last1=Huang|first1=Amy H.|last2=Canner|first2=Joseph K.|last3=Khanna|first3=Raveena|last4=Kang|first4=Sewon|last5=Kwatra|first5=Shawn G.|title=Real-World Prevalence of Prurigo Nodularis and Burden of Associated Diseases|journal=Journal of Investigative Dermatology|volume=140|issue=2|year=2020|pages=480–483.e4|issn=0022202X|doi=10.1016/j.jid.2019.07.697}}</ref>
*This causes the person to rub or scratch the affected area. Constant scratching causes the skin to thicken.  
*The [[pathogenesis]] of LSC is unclear, but clinical lesions are due to severe [[Paroxysm|paroxysmal]] [[Itch|pruritus]]. The physical and emotional component of the cause are well known, compared to genetic, vascular and [[neurogenic]] component.
*The thickened skin itches, causing more scratching, causing more thickening.  
*Skin with [[atopic dermatitis]] and [[atopic]] diathesis is most likely to develop [[Lichenification|lichenification.]]
*There could be a potential relationship between central and peripheral neural tissue and [[inflammatory]] mediators in the perception of itch, leading to changes underlying LSC.
*Emotional disturbances such as [[anxiety]], [[depression]] and [[obsessive-compulsive disorder]] or other stressors contribute to itching in many cases. <ref name="pmid18318884">{{cite journal| author=Lotti T, Buggiani G, Prignano F| title=Prurigo nodularis and lichen simplex chronicus. | journal=Dermatol Ther | year= 2008 | volume= 21 | issue= 1 | pages= 42-6 | pmid=18318884 | doi=10.1111/j.1529-8019.2008.00168.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18318884  }}</ref><ref name="pmid26087735">{{cite journal| author=Tsintsadze N, Beridze L, Tsintsadze N, Krichun Y, Tsivadze N, Tsintsadze M| title=PSYCHOSOMATIC ASPECTS IN PATIENTS WITH DERMATOLOGIC DISEASES. | journal=Georgian Med News | year= 2015 | volume=  | issue= 243 | pages= 70-5 | pmid=26087735 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26087735  }}</ref><ref name="pmid24372057">{{cite journal| author=Liao YH, Lin CC, Tsai PP, Shen WC, Sung FC, Kao CH| title=Increased risk of lichen simplex chronicus in people with anxiety disorder: a nationwide population-based retrospective cohort study. | journal=Br J Dermatol | year= 2014 | volume= 170 | issue= 4 | pages= 890-4 | pmid=24372057 | doi=10.1111/bjd.12811 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24372057  }}</ref>


The skin may become leathery and brownish in the affected area.
*Some studies tried to find genetic support to [[pathology]] of LSC. Like, [[Serotonin]] transporter (5HTT) gene [[polymorphism]] and dysfunction association to LSC <ref name="pmid18986359">{{cite journal| author=Kirtak N, Inaloz HS, Akçali C, Erdal E, Herken H, Yildirim M | display-authors=etal| title=Association of serotonin transporter gene-linked polymorphic region and variable number of tandem repeat polymorphism of the serotonin transporter gene in lichen simplex chronicus patients with psychiatric status. | journal=Int J Dermatol | year= 2008 | volume= 47 | issue= 10 | pages= 1069-72 | pmid=18986359 | doi=10.1111/j.1365-4632.2008.03821.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18986359  }}</ref>.
This disorder may be associated with [[atopic dermatitis]] ([[eczema]]) or [[psoriasis]]. It may also be associated with [[nervousness]], [[anxiety]], [[clinical depression|depression]], and other psychological disorders.
*[[Transient receptor potential channel]] A1 ([[TRPA1]]) which is seen in skin, sensory neuron and other tissues has been associated with decreased expression in the lesions of LSC. <ref name="pmid33183050">{{cite journal| author=Qiu Y, Tang N, Zhang W, Xiong JX, Hu L, Cai T| title=Down-regulated expression of transient receptor potential ankyrin 1 in lichen simplex chronicus. | journal=Ann Palliat Med | year= 2020 | volume= 9 | issue= 6 | pages= 3757-3765 | pmid=33183050 | doi=10.21037/apm-20-1712 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33183050  }}</ref>
*Long interspersed element-1 (LINE-1) pattern changes in epidermis of LSC was found in a study. <ref name="pmid23517394">{{cite journal| author=Yooyongsatit S, Ruchusatsawat K, Supiyaphun P, Noppakun N, Mutirangura A, Wongpiyabovorn J| title=Alterations in the LINE-1 methylation pattern in patients with lichen simplex chronicus. | journal=Asian Pac J Allergy Immunol | year= 2013 | volume= 31 | issue= 1 | pages= 51-7 | pmid=23517394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23517394  }}</ref>


It is common in children, who chronically scratch [[insect bite]]s and other areas. It can also be common in [[mentally retarded]] children who have chronic repetitive movements.
*On [[microscopic]] [[histopathological]] analysis, LSC appears as a [[Hyperkeratosis|hyperkeratotic]] plaque, with [[parakeratosis]], [[Acanthosis nigricans|acanthosis]], spongiosis, [[papillary]] dermal fibrosis with vertical streaking of [[collagen]] bundles, irregularly thickened rete edges, and pseudoepitheliomatous [[hyperplasia]].
*Electron [[microscopy]] shows [[collagen]] fibers attached to and above [[lamina]] basalis.


==Diagnosis==
==Causes==
===Physical Examination===
====Skin====
=====Extremity=====
<gallery>
Image:Lichen simplex10.jpg|Lichen simplex. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>


Image:Lichen simplex09.jpg|Lichen simplex. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
*The most common cause of LSC is emotional factors. Other causes of LSC include
Image:Lichen simplex08.jpg|Lichen simplex. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
**[[Atopic dermatitis]]
**[[Eczema]]
**Mechanical trauma
**Extremes of temperature/humidity
**[[Scar|Scars]]
**[[Xerosis]]
**[[Psoriasis]]
**Insect bites
**[[Lithium]] <ref name="pmid6428244">{{cite journal| author=Shukla S, Mukherjee S| title=Lichen simplex chronicus during lithium treatment. | journal=Am J Psychiatry | year= 1984 | volume= 141 | issue= 7 | pages= 909-10 | pmid=6428244 | doi=10.1176/ajp.141.7.909 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6428244  }}</ref>
**P-phenylenediamine (PPD) <ref name="pmid15291824">{{cite journal| author=Chey WY, Kim KL, Yoo TY, Lee AY| title=Allergic contact dermatitis from hair dye and development of lichen simplex chronicus. | journal=Contact Dermatitis | year= 2004 | volume= 51 | issue= 1 | pages= 5-8 | pmid=15291824 | doi=10.1111/j.0105-1873.2004.00252.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15291824  }}</ref>


Image:Lichen simplex07.jpg|Lichen simplex. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
==Differentiating Lichen simplex chronicus from other Diseases==
Image:Lichen simplex02.jpg|Lichen simplex. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>


Image:Lichen simplex01.jpg|Lichen simplex. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
*Lichen simplex chronicus (LSC) must be differentiated from other diseases that cause thickened [[Skin lesion|skin lesions]] such as:
</gallery>


=====Neck=====
:*[[Atopic dermatitis]]
:*[[Contact dermatitis|Contact allergic dermatitis]]
:*[[Tinea]], [[Candidiasis|candida]] and other fungal infections
:*[[Lichen planus]]
:*[[Psoriasis]]
:*[[Mycosis fungoides]]
:*[[Squamous cell carcinoma]] and others.
==Epidemiology and Demographics==


<gallery>
*LSC has been estimated to occur among 12% of the people around the world.<ref name="Georgieva2016">{{cite journal|last1=Georgieva|first1=Filka|title=CURRENT EPIDEMIOLOGY OF LICHEN SIMPLEX CHRONICUS|journal=Journal of IMAB - Annual Proceeding (Scientific Papers)|volume=22|issue=3|year=2016|pages=1221–1225|issn=1312773X|doi=10.5272/jimab.2016223.1221}}</ref>
===Age===


Image:Lichen simplex06.jpg|Lichen simplex. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
*LSC is more commonly observed among patients aged 30 to 50 years old.
   
===Gender===


Image:Lichen simplex05.jpg|Lichen simplex. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/ Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
*LSC is more commonly affected to females than males.
*The female to male ratio is approximately 2:1.
   
===Race===


</gallery>
*Previous studies in past have shown LSC more common in African Americans and Asians.


=====Trunk=====
==Natural History, Complications and Prognosis==


<gallery>
*[[Prognosis]] is generally good with treatment, but some become persistent lesions.
*Special association with [[erectile dysfunction]] is seen in some studies.<ref name="pmid26076496">{{cite journal| author=Juan CK, Chen HJ, Shen JL, Kao CH| title=Lichen Simplex Chronicus Associated With Erectile Dysfunction: A Population-Based Retrospective Cohort Study. | journal=PLoS One | year= 2015 | volume= 10 | issue= 6 | pages= e0128869 | pmid=26076496 | doi=10.1371/journal.pone.0128869 | pmc=4468076 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26076496  }}</ref><ref name="HwangJuan2015">{{cite journal|last1=Hwang|first1=Shang-Jyh|last2=Juan|first2=Chao-Kuei|last3=Chen|first3=Hsuan-Ju|last4=Shen|first4=Jui-Lung|last5=Kao|first5=Chia-Hung|title=Lichen Simplex Chronicus Associated With Erectile Dysfunction: A Population-Based Retrospective Cohort Study|journal=PLOS ONE|volume=10|issue=6|year=2015|pages=e0128869|issn=1932-6203|doi=10.1371/journal.pone.0128869}}</ref>
*Some cases of [[malignant]] transformation of the lesion into [[squamous cell carcinoma]] or [[verrucous carcinoma]] is seen.


Image:Lichen simplex04.jpg|Lichen simplex. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
==Diagnosis==
===History and Symptoms===


Image:Lichen simplex03.jpg|Lichen simplex. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
*[[Diagnosis]] of LSC includes physical exams, history, and [[Dermatoscope|dermoscopy]]. The most common symptom is [[Itch|Itching]].
*LSC mostly occurs in easy to reach areas like the head, neck, extensor sides of forearm, [[scalp]], [[vulva]], [[pubis]], and [[scrotum]]. It can occur as a single or multiple lesions.
*[[Itching]] usually occurs in the nighttime, and it's mostly absent when active.


</gallery>
===Physical Examination===


=====Genitalia=====
*Lesions appear [[erythematous]], scaly, well-demarcated, rough plaques eventually turning into thickened and [[Hyperpigmentation|hyperpigmented]] due to chronic [[pruritus]].<ref name="SandThomsen2017">{{cite journal|last1=Sand|first1=Freja Lærke|last2=Thomsen|first2=Simon Francis|title=Skin diseases of the vulva: eczematous diseases and contact urticaria|journal=Journal of Obstetrics and Gynaecology|volume=38|issue=3|year=2017|pages=295–300|issn=0144-3615|doi=10.1080/01443615.2017.1329283}}</ref><ref name="Chibnall2017">{{cite journal|last1=Chibnall|first1=Rebecca|title=Vulvar Pruritus and Lichen Simplex Chronicus|journal=Obstetrics and Gynecology Clinics of North America|volume=44|issue=3|year=2017|pages=379–388|issn=08898545|doi=10.1016/j.ogc.2017.04.003}}</ref>
*These [[plaques]] can vary in size from 3 by 6 centimeters to 6 by 10 centimeters. The color of the lesion varies according to the stage of the lesion.


<gallery>
===Laboratory Findings===


Image:Lichen simplex16.jpg|Lichen simplex. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
*There are no specific laboratory findings associated with LSC.
*You can do few tests to identify the stressor behind the disease like serum [[Immunoglobulin E|IgE]] levels to support underlying [[atopy]].


Image:Lichen simplex15.jpg|Lichen simplex. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
===Other Diagnostic Studies===


Image:Lichen simplex12.jpg|Lichen simplex. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
*Patch test can exclude possible allergic [[contact dermatitis]] as a cause of disease.<ref name="pmid28492056">{{cite journal| author=Fruchter R, Melnick L, Pomeranz MK| title=Lichenoid vulvar disease: A review. | journal=Int J Womens Dermatol | year= 2017 | volume= 3 | issue= 1 | pages= 58-64 | pmid=28492056 | doi=10.1016/j.ijwd.2017.02.017 | pmc=5419035 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28492056  }}</ref><ref name="pmid28785363">{{cite journal| author=Voicu C, Tebeica T, Zanardelli M, Mangarov H, Lotti T, Wollina U | display-authors=etal| title=Lichen Simplex Chronicus as an Essential Part of the Dermatologic Masquerade. | journal=Open Access Maced J Med Sci | year= 2017 | volume= 5 | issue= 4 | pages= 556-557 | pmid=28785363 | doi=10.3889/oamjms.2017.133 | pmc=5535688 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28785363  }}</ref><ref name="pmid29641708">{{cite journal| author=Muylaert BPB, Borges MT, Michalany AO, Scuotto CRC| title=Lichen simplex chronicus on the scalp: exuberant clinical, dermoscopic, and histopathological findings. | journal=An Bras Dermatol | year= 2018 | volume= 93 | issue= 1 | pages= 108-110 | pmid=29641708 | doi=10.1590/abd1806-4841.20186493 | pmc=5871373 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29641708 }}</ref><ref name="pmid28778638">{{cite journal| author=Chibnall R| title=Vulvar Pruritus and Lichen Simplex Chronicus. | journal=Obstet Gynecol Clin North Am | year= 2017 | volume= 44 | issue= 3 | pages= 379-388 | pmid=28778638 | doi=10.1016/j.ogc.2017.04.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28778638  }}</ref><ref name="pmid28780897">{{cite journal| author=Sand FL, Thomsen SF| title=Skin diseases of the vulva: eczematous diseases and contact urticaria. | journal=J Obstet Gynaecol | year= 2018 | volume= 38 | issue= 3 | pages= 295-300 | pmid=28780897 | doi=10.1080/01443615.2017.1329283 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28780897  }}</ref>
*[[Potassium hydroxide examination]] and fungal cultures help to eliminate tinea cruris and [[candidal]] infections, especially when the lesions are involved with [[genitals]].
*Skin [[Biopsy|biopsies]] may be performed to exclude [[psoriasis]] or [[mycosis fungoides]].


Image:Lichen simplex13.jpg|Lichen simplex. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
==Treatment==
===Medical Therapy===


</gallery>
*The mainstay of therapy for LSC is to reduce [[pruritus]] and support the [[lesion]] and body to heal.
*Topical [[anti-inflammatory]] therapy like [[Corticosteroid|corticosteroids]], topical [[Emollient|emollients]], [[anti-histamines]], and [[antibiotics]] if suspicion of secondary infection.
*[[Corticosteroids]] decreases the [[inflammation]], and also improve the lesion [[hyperkeratosis]].
*Depending on the size, extent and location of [[lesion]], choice of [[corticosteroid]] (mild or high potent topical preparations) is made.
*Intralesional [[steroid]] injections are used for [[refractory]] cases.<ref name="pmid1757609">{{cite journal| author=Brunner N, Yawalkar S| title=A double-blind, multicenter, parallel-group trial with 0.05% halobetasol propionate ointment versus 0.1% diflucortolone valerate ointment in patients with severe, chronic atopic dermatitis or lichen simplex chronicus. | journal=J Am Acad Dermatol | year= 1991 | volume= 25 | issue= 6 Pt 2 | pages= 1160-3 | pmid=1757609 | doi=10.1016/0190-9622(91)70317-u | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1757609  }}</ref><ref name="pmid1757608">{{cite journal| author=Datz B, Yawalkar S| title=A double-blind, multicenter trial of 0.05% halobetasol propionate ointment and 0.05% clobetasol 17-propionate ointment in the treatment of patients with chronic, localized atopic dermatitis or lichen simplex chronicus. | journal=J Am Acad Dermatol | year= 1991 | volume= 25 | issue= 6 Pt 2 | pages= 1157-60 | pmid=1757608 | doi=10.1016/0190-9622(91)70316-t | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1757608  }}</ref>
*Occlusion has been observed to improve the treatment effectiveness. Also, it prevents from scratching. <ref name="pmid2583907">{{cite journal| author=Geraldez MC, Carreon-Gavino M, Hoppe G, Costales A| title=Diflucortolone valerate ointment with and without occlusion in lichen simplex chronicus. | journal=Int J Dermatol | year= 1989 | volume= 28 | issue= 9 | pages= 603-4 | pmid=2583907 | doi=10.1111/j.1365-4362.1989.tb02538.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2583907  }}</ref>
*[[Psychology|Psychological]] treatment, such as [[psychotherapy]], as well as drugs like anti-anxiety medications are found to be effective, because of the emotional factors of the disease.
*Other treatments like [[doxepin]] and [[capsaicin]], [[aspirin]]/[[dichloromethane]], [[Immunomodulator|immunomodulators]] like [[tacrolimus]] and [[pimecrolimus]], and injections of [[botulinum]] toxins. <ref name="pmid25752318">{{cite journal| author=Day T, Bohl TG, Scurry J| title=Perianal lichen dermatoses: A review of 60 cases. | journal=Australas J Dermatol | year= 2016 | volume= 57 | issue= 3 | pages= 210-5 | pmid=25752318 | doi=10.1111/ajd.12308 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25752318  }}</ref>


==Treatment==
===Surgical/ Other therapy===


Treatment is aimed at reducing itching and minimizing existing lesions because rubbing and scratching cause LSC. The itching and inflammation may be treated with a lotion or [[steroid]] cream applied to the affected area of the skin.
*[[Cryosurgery]], [[Phototherapy]], Photochemotherapy and [[Transcutaneous Electrical Nerve Stimulation]] have been studied in cases not responsive to any of the medical therapy. <ref name="pmid19175614">{{cite journal| author=Engin B, Tufekci O, Yazici A, Ozdemir M| title=The effect of transcutaneous electrical nerve stimulation in the treatment of lichen simplex: a prospective study. | journal=Clin Exp Dermatol | year= 2009 | volume= 34 | issue= 3 | pages= 324-8 | pmid=19175614 | doi=10.1111/j.1365-2230.2008.03086.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19175614  }}</ref>


==See also==
===Prevention===


* [[Pruritus]]
*Effective measures for the primary prevention of LSC include helping patients to minimize scratching on an individual basis. Treating the underlying mental disorder if it's involved in the [[etiology]] of disease.
 
{{Diseases of the skin and subcutaneous tissue}}


==References==
{{Reflist|2}}
[[Category:Dermatology]]
[[Category:Dermatology]]
 
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Latest revision as of 16:46, 5 July 2021


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karnik Raju Paila Bangaru, M.B.B.S.[2]

Synonyms and keywords: Neurodermatitis, neurodermatitides, circumscribed neurodermatitis, circumscribed neurodermatitides, localized neurodermatitis, localized neurodermatitides

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Overview

Lichen simplex chronicus (LSC) is a chronic skin condition associated with a persistent itch-scratch cycle, leading to a thick, leathery, dark (lichenified) skin. Similar to many other skin conditions, it may present with associated dryness, scaling, or erythema. Commonly affected regions include neck, ankles, extremities, scalp and genital region. The incidence and prevalence of the condition are not well established, but this is observed to be more common in adult female patients. The pathophysiology remains unclear, but it's thought to arise from disturbances between central and peripheral neural tissue in the perception of itch, causing that persistent itch-scratch cycle. Several psychological disturbances like anxiety and depression have been associated with this dermatological condition.

Pathophysiology

  • Some studies tried to find genetic support to pathology of LSC. Like, Serotonin transporter (5HTT) gene polymorphism and dysfunction association to LSC [8].
  • Transient receptor potential channel A1 (TRPA1) which is seen in skin, sensory neuron and other tissues has been associated with decreased expression in the lesions of LSC. [9]
  • Long interspersed element-1 (LINE-1) pattern changes in epidermis of LSC was found in a study. [10]

Causes

Differentiating Lichen simplex chronicus from other Diseases

  • Lichen simplex chronicus (LSC) must be differentiated from other diseases that cause thickened skin lesions such as:

Epidemiology and Demographics

  • LSC has been estimated to occur among 12% of the people around the world.[13]

Age

  • LSC is more commonly observed among patients aged 30 to 50 years old.

Gender

  • LSC is more commonly affected to females than males.
  • The female to male ratio is approximately 2:1.

Race

  • Previous studies in past have shown LSC more common in African Americans and Asians.

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

  • Diagnosis of LSC includes physical exams, history, and dermoscopy. The most common symptom is Itching.
  • LSC mostly occurs in easy to reach areas like the head, neck, extensor sides of forearm, scalp, vulva, pubis, and scrotum. It can occur as a single or multiple lesions.
  • Itching usually occurs in the nighttime, and it's mostly absent when active.

Physical Examination

  • Lesions appear erythematous, scaly, well-demarcated, rough plaques eventually turning into thickened and hyperpigmented due to chronic pruritus.[16][17]
  • These plaques can vary in size from 3 by 6 centimeters to 6 by 10 centimeters. The color of the lesion varies according to the stage of the lesion.

Laboratory Findings

  • There are no specific laboratory findings associated with LSC.
  • You can do few tests to identify the stressor behind the disease like serum IgE levels to support underlying atopy.

Other Diagnostic Studies

Treatment

Medical Therapy

Surgical/ Other therapy

Prevention

  • Effective measures for the primary prevention of LSC include helping patients to minimize scratching on an individual basis. Treating the underlying mental disorder if it's involved in the etiology of disease.

References

  1. ↑ Juarez, Michelle C.; Kwatra, Shawn G. (2020). "A systematic review of evidence based treatments for lichen simplex chronicus". Journal of Dermatological Treatment: 1–9. doi:10.1080/09546634.2019.1708856. ISSN 0954-6634.
  2. ↑ Boozalis, Emily; Tang, Olive; Patel, Shivani; Semenov, Yevgeniy R.; Pereira, Manuel P.; Stander, Sonja; Kang, Sewon; Kwatra, Shawn G. (2018). "Ethnic differences and comorbidities of 909 prurigo nodularis patients". Journal of the American Academy of Dermatology. 79 (4): 714–719.e3. doi:10.1016/j.jaad.2018.04.047. ISSN 0190-9622.
  3. ↑ Whang KA, Khanna R, Thomas J, Aguh C, Kwatra SG (2019). "Racial and Gender Differences in the Presentation of Pruritus". Medicines (Basel). 6 (4). doi:10.3390/medicines6040098. PMC 6963580 Check |pmc= value (help). PMID 31569651.
  4. ↑ Huang, Amy H.; Canner, Joseph K.; Khanna, Raveena; Kang, Sewon; Kwatra, Shawn G. (2020). "Real-World Prevalence of Prurigo Nodularis and Burden of Associated Diseases". Journal of Investigative Dermatology. 140 (2): 480–483.e4. doi:10.1016/j.jid.2019.07.697. ISSN 0022-202X.
  5. ↑ Lotti T, Buggiani G, Prignano F (2008). "Prurigo nodularis and lichen simplex chronicus". Dermatol Ther. 21 (1): 42–6. doi:10.1111/j.1529-8019.2008.00168.x. PMID 18318884.
  6. ↑ Tsintsadze N, Beridze L, Tsintsadze N, Krichun Y, Tsivadze N, Tsintsadze M (2015). "PSYCHOSOMATIC ASPECTS IN PATIENTS WITH DERMATOLOGIC DISEASES". Georgian Med News (243): 70–5. PMID 26087735.
  7. ↑ Liao YH, Lin CC, Tsai PP, Shen WC, Sung FC, Kao CH (2014). "Increased risk of lichen simplex chronicus in people with anxiety disorder: a nationwide population-based retrospective cohort study". Br J Dermatol. 170 (4): 890–4. doi:10.1111/bjd.12811. PMID 24372057.
  8. ↑ Kirtak N, Inaloz HS, Akçali C, Erdal E, Herken H, Yildirim M; et al. (2008). "Association of serotonin transporter gene-linked polymorphic region and variable number of tandem repeat polymorphism of the serotonin transporter gene in lichen simplex chronicus patients with psychiatric status". Int J Dermatol. 47 (10): 1069–72. doi:10.1111/j.1365-4632.2008.03821.x. PMID 18986359.
  9. ↑ Qiu Y, Tang N, Zhang W, Xiong JX, Hu L, Cai T (2020). "Down-regulated expression of transient receptor potential ankyrin 1 in lichen simplex chronicus". Ann Palliat Med. 9 (6): 3757–3765. doi:10.21037/apm-20-1712. PMID 33183050 Check |pmid= value (help).
  10. ↑ Yooyongsatit S, Ruchusatsawat K, Supiyaphun P, Noppakun N, Mutirangura A, Wongpiyabovorn J (2013). "Alterations in the LINE-1 methylation pattern in patients with lichen simplex chronicus". Asian Pac J Allergy Immunol. 31 (1): 51–7. PMID 23517394.
  11. ↑ Shukla S, Mukherjee S (1984). "Lichen simplex chronicus during lithium treatment". Am J Psychiatry. 141 (7): 909–10. doi:10.1176/ajp.141.7.909. PMID 6428244.
  12. ↑ Chey WY, Kim KL, Yoo TY, Lee AY (2004). "Allergic contact dermatitis from hair dye and development of lichen simplex chronicus". Contact Dermatitis. 51 (1): 5–8. doi:10.1111/j.0105-1873.2004.00252.x. PMID 15291824.
  13. ↑ Georgieva, Filka (2016). "CURRENT EPIDEMIOLOGY OF LICHEN SIMPLEX CHRONICUS". Journal of IMAB - Annual Proceeding (Scientific Papers). 22 (3): 1221–1225. doi:10.5272/jimab.2016223.1221. ISSN 1312-773X.
  14. ↑ Juan CK, Chen HJ, Shen JL, Kao CH (2015). "Lichen Simplex Chronicus Associated With Erectile Dysfunction: A Population-Based Retrospective Cohort Study". PLoS One. 10 (6): e0128869. doi:10.1371/journal.pone.0128869. PMC 4468076. PMID 26076496.
  15. ↑ Hwang, Shang-Jyh; Juan, Chao-Kuei; Chen, Hsuan-Ju; Shen, Jui-Lung; Kao, Chia-Hung (2015). "Lichen Simplex Chronicus Associated With Erectile Dysfunction: A Population-Based Retrospective Cohort Study". PLOS ONE. 10 (6): e0128869. doi:10.1371/journal.pone.0128869. ISSN 1932-6203.
  16. ↑ Sand, Freja Lærke; Thomsen, Simon Francis (2017). "Skin diseases of the vulva: eczematous diseases and contact urticaria". Journal of Obstetrics and Gynaecology. 38 (3): 295–300. doi:10.1080/01443615.2017.1329283. ISSN 0144-3615.
  17. ↑ Chibnall, Rebecca (2017). "Vulvar Pruritus and Lichen Simplex Chronicus". Obstetrics and Gynecology Clinics of North America. 44 (3): 379–388. doi:10.1016/j.ogc.2017.04.003. ISSN 0889-8545.
  18. ↑ Fruchter R, Melnick L, Pomeranz MK (2017). "Lichenoid vulvar disease: A review". Int J Womens Dermatol. 3 (1): 58–64. doi:10.1016/j.ijwd.2017.02.017. PMC 5419035. PMID 28492056.
  19. ↑ Voicu C, Tebeica T, Zanardelli M, Mangarov H, Lotti T, Wollina U; et al. (2017). "Lichen Simplex Chronicus as an Essential Part of the Dermatologic Masquerade". Open Access Maced J Med Sci. 5 (4): 556–557. doi:10.3889/oamjms.2017.133. PMC 5535688. PMID 28785363.
  20. ↑ Muylaert BPB, Borges MT, Michalany AO, Scuotto CRC (2018). "Lichen simplex chronicus on the scalp: exuberant clinical, dermoscopic, and histopathological findings". An Bras Dermatol. 93 (1): 108–110. doi:10.1590/abd1806-4841.20186493. PMC 5871373. PMID 29641708.
  21. ↑ Chibnall R (2017). "Vulvar Pruritus and Lichen Simplex Chronicus". Obstet Gynecol Clin North Am. 44 (3): 379–388. doi:10.1016/j.ogc.2017.04.003. PMID 28778638.
  22. ↑ Sand FL, Thomsen SF (2018). "Skin diseases of the vulva: eczematous diseases and contact urticaria". J Obstet Gynaecol. 38 (3): 295–300. doi:10.1080/01443615.2017.1329283. PMID 28780897.
  23. ↑ Brunner N, Yawalkar S (1991). "A double-blind, multicenter, parallel-group trial with 0.05% halobetasol propionate ointment versus 0.1% diflucortolone valerate ointment in patients with severe, chronic atopic dermatitis or lichen simplex chronicus". J Am Acad Dermatol. 25 (6 Pt 2): 1160–3. doi:10.1016/0190-9622(91)70317-u. PMID 1757609.
  24. ↑ Datz B, Yawalkar S (1991). "A double-blind, multicenter trial of 0.05% halobetasol propionate ointment and 0.05% clobetasol 17-propionate ointment in the treatment of patients with chronic, localized atopic dermatitis or lichen simplex chronicus". J Am Acad Dermatol. 25 (6 Pt 2): 1157–60. doi:10.1016/0190-9622(91)70316-t. PMID 1757608.
  25. ↑ Geraldez MC, Carreon-Gavino M, Hoppe G, Costales A (1989). "Diflucortolone valerate ointment with and without occlusion in lichen simplex chronicus". Int J Dermatol. 28 (9): 603–4. doi:10.1111/j.1365-4362.1989.tb02538.x. PMID 2583907.
  26. ↑ Day T, Bohl TG, Scurry J (2016). "Perianal lichen dermatoses: A review of 60 cases". Australas J Dermatol. 57 (3): 210–5. doi:10.1111/ajd.12308. PMID 25752318.
  27. ↑ Engin B, Tufekci O, Yazici A, Ozdemir M (2009). "The effect of transcutaneous electrical nerve stimulation in the treatment of lichen simplex: a prospective study". Clin Exp Dermatol. 34 (3): 324–8. doi:10.1111/j.1365-2230.2008.03086.x. PMID 19175614.

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