Lichen Simplex Chronicus - Causes, Symptoms and Treatment
Lichen simplex chronicus is a chronic inflammation of the skin characterized by small, round itchy spots as a result of repeated scratching and rubbing. It is characterized by small, intensely pruritic papules.The skin eruption is created by habitually scratching a certain area over a long period of time. This scratching causes characteristic changes such as thickening and darkening of the skin, and an accentuation of normal skin lines. These changes are called lichenification.
Lichen simplex, also called neurodermatitis. It generally affects adults, and may result in one, or many itchy patches. Lichen Simplex Chronicus is seen in people with eczema. Stress and depression exacerbate lichen simplex chronicus (LSC). LSC often has a chronic, waxing-and-waning course that parallels the patient's changes in emotions.
The possible causes of lichen simplex chronicus are :-
- The main cause of it comes, when something that rubs, irritates, or scratches the skin, such as clothing. The thickened skin may become leathery and brownish in the affected area.
- Long-term exposure to street traffic may be associated with an increase in the frequency of childhood skin diseases, including LSC.
- Atopic dermatitis, is also the main cause of lichen simplex chronicus.
- Psychological factors play important role in the development or exacerbation of LSC.
- Lithium has been linked to LSC in one reported case. LSC was dependent on the administration of lithium as evidenced by the observation that the LSC remitted when the medication was discontinued and recurred when it was restarted.
- Lichen simplex chronicus may be associated with nervousness, anxiety, depression, and other psychologic disorders.
- It is common in children and mentally retarded children or who chronically scratch insect bites and other areas.
The most common symptoms of lichen simplex chronicus are :-
- Symptoms are chronic itching which is often accompanied by nervous tension.
- It may located on the ankle, wrist, neck, rectum/anal area, forearms, thighs, lower leg, back of the knee, inner elbow
- The appearance of scratch marks and the leathery skin patches can be found anywhere on the body.
- There may be skin lesion , patch, or plaque over the affected area. Skin lesion becomes leathery textured.
- The affected skin get Darkened or reddened.
- The itchiness tends to come and go. It may be most noticeable when you're at rest ,watching TV or sleeping, and disappear when you're active.
Treatment of lichen simplex chronicus may include:
- Topical steroids: These are very effective because they decrease inflammation and itch.
- Corticosteroids creams may also be used over the affected area.
- The injections of corticosteroids may be given into the affected area to reduce itching and inflammation.
- topical antibiotics like bacitracin help prevent infection. These should be used early to forestall further damage to the skin.
- Topical aspirin/dichloromethane is effective in patients with LSC who have not responded to topical corticosteroids.
- Sedatives and tranquilizers are very effective to get relief from stress.
- Oral antianxiety medications may be used for the treatment of lichen simplex chronicus.
- Antihistamines such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) are common. Doxepin (Sinequan) and clonazepam (Klonopin) may be considered in appropriate cases.
- Steroid creams: Apply a thin layer of the steroid cream to the affected areas at night. Continue until the patch has flattened with the normal skin.