Lichen simplex chronicus

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] Kiran Singh, M.D. [3]

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

WikiDoc Resources for Lichen simplex chronicus
Articles
Most recent articles on Lichen simplex chronicus Most cited articles on Lichen simplex chronicus Review articles on Lichen simplex chronicus Articles on Lichen simplex chronicus in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Lichen simplex chronicus Images of Lichen simplex chronicus Photos of Lichen simplex chronicus Podcasts & MP3s on Lichen simplex chronicus Videos on Lichen simplex chronicus
Evidence Based Medicine
Cochrane Collaboration on Lichen simplex chronicus Bandolier on Lichen simplex chronicus TRIP on Lichen simplex chronicus
Clinical Trials
Ongoing Trials on Lichen simplex chronicus at Clinical Trials.gov Trial results on Lichen simplex chronicus Clinical Trials on Lichen simplex chronicus at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Lichen simplex chronicus NICE Guidance on Lichen simplex chronicus NHS PRODIGY Guidance FDA on Lichen simplex chronicus CDC on Lichen simplex chronicus
Books
Books on Lichen simplex chronicus
News
Lichen simplex chronicus in the news Be alerted to news on Lichen simplex chronicus News trends on Lichen simplex chronicus
Commentary
Blogs on Lichen simplex chronicus
Definitions
Definitions of Lichen simplex chronicus
Patient Resources / Community
Patient resources on Lichen simplex chronicus Discussion groups on Lichen simplex chronicus Patient Handouts on Lichen simplex chronicus Directions to Hospitals Treating Lichen simplex chronicus Risk calculators and risk factors for Lichen simplex chronicus
Healthcare Provider Resources
Symptoms of Lichen simplex chronicus Causes & Risk Factors for Lichen simplex chronicus Diagnostic studies for Lichen simplex chronicus Treatment of Lichen simplex chronicus
Continuing Medical Education (CME)
CME Programs on Lichen simplex chronicus
International
Lichen simplex chronicus en Espanol Lichen simplex chronicus en Francais
Business
Lichen simplex chronicus in the Marketplace Patents on Lichen simplex chronicus
Experimental / Informatics
List of terms related to Lichen simplex chronicus

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 its thought to arise from disturbances between central and peripheral neural tissue in the perception of itch, causing the persistent itch-scratch cycle. Several psychological disturbances like anxiety and depression have been associated with this dermatological condition.

Pathophysiology

• LSC develops over the regions which are accessible to scratching.
• The pathogenesis of LSC is unclear, but clinical lesions are due to severe paroxysmal pruritus. The physical and emotional component of the cause are well known, compared to genetic, vascular and neurogenic component.
• Skin with atopic dermatitis and atopic diathesis is most likely to develop lichenification.
• There could be a potential relationship between central and peripheral neural tissue and inflammatory mediators in the perception of itch, and leading to changes.
• Emotional disturbances such as anxiety, depression and obsessive-compulsive disorder or other stressors contribute to itching in many cases.
• Some studies tried to find genetic support to pathology. Like, Serotonin transporter (5HTT) gene polymorphism and dysfunction association to LSC . 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. Long interspersed element-1 (LINE-1) pattern changes in epidermis of LSC was found in a study.
• On microscopic histopathological analysis, LSC appears as a hyperkeratotic plaque, with parakeratosis, 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.
• "Lichen Simplex Chronicus - StatPearls - NCBI Bookshelf". "Lichen Simplex Chronicus: Background, Pathophysiology, Etiology".

Causes

The most common cause of LSC is emotional factors. Other causes of LSC include atopic dermatitis, eczema, mechanical trauma, scars, xerosis, psoriasis, lithium , p-phenylenediamine (PPD) , and others.

Differentiating [disease name] from other Diseases

• [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:

• [Differential dx1]
• [Differential dx2]
• [Differential dx3]

Epidemiology and Demographics

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

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 have shown LSC more common in African Americans and Asians.

Natural History, Complications and Prognosis

• The majority of patients with [disease name] remain asymptomatic for [duration/years].
• Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
• If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
• Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
• Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].

Diagnosis

Diagnostic Criteria

• The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:

• [criterion 1]
• [criterion 2]
• [criterion 3]
• [criterion 4]

History and Symptoms

• [Disease name] is usually asymptomatic.
• Symptoms of [disease name] may include the following:

• [symptom 1]
• [symptom 2]
• [symptom 3]
• [symptom 4]
• [symptom 5]
• [symptom 6]

Physical Examination

• Patients with [disease name] usually appear [general appearance].
• Physical examination may be remarkable for:

• [finding 1]
• [finding 2]
• [finding 3]
• [finding 4]
• [finding 5]
• [finding 6]

Laboratory Findings

• There are no specific laboratory findings associated with [disease name].

• A [positive/negative] [test name] is diagnostic of [disease name].
• An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
• Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

Electrocardiogram

There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

X-ray

There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

CT scan

There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

MRI

There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Other Imaging Findings

There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

• There is no treatment for [disease name]; the mainstay of therapy is supportive care.

• The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
• [Medical therapy 1] acts by [mechanism of action 1].
• Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

• Surgery is the mainstay of therapy for [disease name].
• [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
• [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention

• There are no primary preventive measures available for [disease name].

• Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

• Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].