What is Lichen Simplex Chronicus?
Lichen simplex chronicus is a condition characterized by chronic itching and scratching resulting to thickening of the skin making the texture and appearance of the skin somewhat similar to a leather.
Lichen simplex chronicus is also known as Neurodermatitis and is a type of eczema or dermatitis. The international frequency of the disease remains unknown although it can affect the general population. No racial predilection is also noted although there have been reports of its prevalence among African Americans and Asians. This skin condition can affect both males and females although it is more common among females. Lichen simplex chronicus is rare in children and often occurs in people in mid adult or in late adulthood with peak onset of 30 years to 50 years.
Lichen simplex chronicus is not a serious or life-threatening condition but is generally itchy which can provoke an itching and scratching habit. The condition is especially aggravated when an affected individual remains immobile. The plaques of lichen simplex chronicus are common in the areas such as the nape of the neck, elbow, and calf and in the genitalia. The lesion causes the hair in the affected area to break off. Lichen simplex chronicus can be persistent and it can recur even after it has been treated. The incidence of lichen simplex chronicus however, can have a major impact in life as the disease can be very discomforting aside from the unappealing appearance of the lesion which can cause embarrassment on part of the patient thereby affecting the quality of life.
The main concern in lichen simplex chronicus is the lichenification brought by incessant itching and scratching resulting to a mechanical trauma to the skin. Emotional stress is believed to play a role in the process of this skin condition. The incessant scratching can also cause a break in the continuity of the skin making it potential for infection. Lichen simplex chronicus can also result to vulvodynia and vestibulitis in women.
The primary symptom of lichen simplex chronicus is an intense itching that will provoke incessant scratching of the affected area. The disease often affects a single area such as in the nape of the neck, elbow, wrist, calf, thighs and the genitalia. The scrotum of men and the vulva of women is the most common area of the genitals that are often affected by lichen simplex chronicus.
The primary concern in lichen simplex chronicus is the intense itching that can provoke an incessant desire to scratch off the itchiness causing a habit of itch-scratch cycle. Itchiness or pruritus is prominent during the early course of the lesion.
The common signs and symptoms of lichen simplex chronicus include the following:
- Itchiness in a single and limited area of the skin
- Formation of plaque or lichenification that is elevated from the skin surface
- The plaques are firm and rough in texture often similar to the appearance of a leather
- Hyperpigmentation or changes in the pigment of the skin surrounding the patches occurs
- A cutaneous horn may also develop due to the hyperkeratotic process of the disease
- Ulceration, erosion and white marks or scratches may also occur due to non-stop scratching and rubbing of the affected area of the skin
- The core or the center of the plaque often has the densest lichenification and has the most color changes
- Lichen simplex chronicus is often found in one side of the body although it may also affect both sides of the body
- The hair on the affected area of the skin are often broken off
- The size of the plaque is about 2cm to 3cm wide or about the size of a palm of the hand
- Itchiness is intermittent and is often relieved with scratching
People with lichen simplex chronicus may also suffer from the following:
- A disturbed sleep due to intense itchiness
- Itchiness that intensifies or persists when the affected person is idle
- A discomfort that can affect the daily routine
- Itchiness creating a bad habit of scratching even in the absence of itchiness or in perception of itch
- It is advisable that a doctor be seen when the lesion turns infected which can be seen with signs of secretion of yellowish fluid or pus, thick skin and pain
- The skin of the affected area becomes painful
The exact cause of lichen simplex chronicus is not known. The pathophysiology of the condition initially starts with irritants that can trigger the itchiness. Several factors are believed to play a role in triggering the itch response.
Insect bite is one of the most common influences of itchiness that can provoke scratching to naturally relieve the itchiness. Various types of insects can cause the itchiness immediately after it has come into contact with the skin of human.
Atopic dermatitis or eczema is one of the most commonly implicated in the development of lichenification as a result of mechanical trauma to the skin. Atopic dermatitis is an inflammatory skin condition that is characterized by itching along with the development of dry and scaly skin.
Psychological factors such as anxiety depression is believed to play a role in the onset of lichen simplex chronicus. The onset of lichen simplex chronicus is deemed to be the result of anxiety and nervousness that played a role in the pathological process of the progression of the condition.
The goal of treatment in lichen simplex chronicus is to diminish the itch response while inhibiting the progression of the lesion that resulted from incessant scratching. The primary concern is to cease scratching by suppressing the trigger of the itch response. The priority is to identify the cause of intense itchiness thereby putting a stop to incessant scratching which is potential for the development of lichen simplex chronicus.
Medications are prescribed to reduce the intensity or to control the trigger of itchiness.
Antihistamines are usually prescribed for lichen simplex chronicus to relieve the symptoms of itchiness.
Anti-anxiety medications are especially given to lichen simplex chronicus triggered by psychological factors such as anxiety and depression. Treatment of lichen simplex chronicus however, is just part of the treatment of the primary concern.
Corticosteroids are beneficial in relieving the itchiness. Over-the-counter corticosteroids are especially helpful. Stronger dosage however, is more helpful in severe cases but prescription from a doctor is necessary.
Phototherapy is especially helpful for those with severe case of lichen simplex chronicus. This method of treatment is indicated for patient with widespread lichenification.