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Lichen Simplex Chronicus is basically localized itchy, well defined eruption. It usually starts with small papules that join together to become plaques. The chronic nature of this condition can be troubling. The skin thickens in response to rubbing and scratching (lichenification). Increased skin markings occur often in a cross-hatch pattern. Nodules may sometimes occur as part of the thickening skin. Lichen simplex chronicus is a skin disorder characterized by chronic itching and scratching. The constant scratching causes thick, leathery, brownish skin. Neurodermatitis isn't serious - but breaking the itch-scratch cycle can be challenging. Successful treatment depends on identifying and eliminating factors that may be aggravating the problem.
Symptoms of Lichen Simplex Chronicus
The primary symptom of neurodermatitis is itchy skin - often on the neck, wrist, forearm, thigh or ankle. Sometimes neurodermatitis affects genital areas, such as the vulva or scrotum. The symptoms are :
- Itching of the skin
- May be chronic
- May be intense
- Increases with nervous tension, stress
- Skin lesion , patch, or plaque
- Exaggerated skin lines over the lesion
- Circumscribed lesion with distinct borders
- Skin lesion becomes leathery textured ( lichenification )
- Darkened (hyperpigmented) or reddened skin
- Excoriation, raw areas
- Scratch marks
- Scaling
- Commonly located on the ankle, wrist, neck, rectum/anal area, forearms, thighs, lower leg, back of the knee, inner elbow
Causes of Lichen Simplex Chronicus
This is a skin disorder characterized by a self-perpetuating scratch-itch cycle:
- 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.
- Insect bites, scars (eg, traumatic, postherpetic/zoster), acne keloidalis nuchae, xerosis, venous insufficiency, and asteatotic eczema are common factors.
- The appearance of scratch marks and the leathery skin patches can be found anywhere on the body
- Neurodermatitis is a term formerly used interchangeably with LSC, suggesting a role of anxiety or obsession as part of the pathological process of developing lesions.
- A small study looking at LSC and the use of PPD-containing hair dye showed clinically relevant improvement in symptoms after discontinuation of PPD exposure, thus providing a basis for the role of sensitization and contact dermatitis in the etiology of LSC.
Treatment of Lichen Simplex Chronicus
Treatment of the itching is necessary to stop the scratching and resulting skin damage. The primary treatment is to stop scratching the skin. The aim of treatment is to stop the itch/scratch cycle. Potent topical steroids are usually required. Other treatment list are below:
- The itching and inflammation may be treated with a lotion or steroid cream applied to the affected area of the skin.
- In persistent lesions a biopsy is required to rule out any other pathology. Occasionally patch testing may also be of value.
- Bandages or dressings can help protect the affected area. This may be especially important if you scratch during your sleep.
- For infected lesions, a topical or oral antibiotic can be considered.
- Oral antianxiety medications and sedation may be considered in certain patients. According to individual need, treatment can be scheduled throughout the day, at bedtime, or both. Antihistamines such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) are common.
- Antidepressants and tranquilizers may be needed in those patients who have an emotional component to their lichen simplex chronicus.
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