Lichen simplex chronicus (LSC) is thick leathery skin with exaggerated skin markings caused by sudden

itching Itch (also known as pruritus) is a Wikt:sensation, sensation that causes the desire or reflex to scratch. Itch has resisted many attempts to be classified as any one type of Sensory system, sensory experience. Itch has many similarities to pain, ...

and excessive rubbing and

scratching Scratching, sometimes referred to as scrubbing, is a DJ and turntablist technique of moving a vinyl record back and forth on a turntable to produce percussive or rhythmic sounds. A crossfader on a DJ mixer may be used to fade between two record ...

. It generally results in small bumps, patches, scratch marks and scale. It typically affects the neck, scalp, upper eyelids, ears, palms, soles, ankles, wrists, genital areas and bottom. It often develops gradually and the scratching becomes a habit.

Signs and symptoms

People burdened with LSC report

pruritus Itch (also known as pruritus) is a sensation that causes the desire or reflex to scratch. Itch has resisted many attempts to be classified as any one type of sensory experience. Itch has many similarities to pain, and while both are unpleasant ...

, followed by uncontrollable scratching of the same body region, excessively. Most common sites of LSC are the sides of the neck, the scalp, ankles, vulva, pubis, scrotum, and extensor sides of the forearms. However, due to the stigma associated with chronic scratching, some patients will not admit to chronic rubbing or abrasion. The skin may become thickened and hyperpigmented (lichenified) as a direct result of chronic excoriation. Typically this period of increased scratching is associated with stressors.

Causes

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. *Affected area may spread rapidly through the rest of the body. Many hypothesize LSC has a psychosomatic origin. Those predisposed to itch as a response to emotional tensions may be more susceptible to the itch-scratch cycle. It may also be associated with nervousness,

anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...

, depression, and other psychological disorders. Many people with LSC are aware of the scratching they do during the day, but they might not be aware of the scratching they do in their sleep. LSC is also associated with

atopy Atopy is the tendency to produce an exaggerated immunoglobulin E (IgE) immune response to otherwise harmless substances in the environment. Allergic diseases are clinical manifestations of such inappropriate, atopic responses. Atopy may have a ...

, or atopic dermatitis (eczema) and an increase of histamine levels.

Diagnosis

LSC is typically diagnosed by careful observation and history taking. It is easily recognized (see ''signs and symptoms'', and ''gallery''). Biopsies are sometimes necessary to confirm the diagnosis and differentiate it from other similar appearing lesions.

Treatment

Treatment is aimed at reducing itching and minimizing existing lesions because rubbing and scratching exacerbate LSC. The itching and inflammation may be treated with a lotion or steroid cream (such as

triamcinolone Triamcinolone is a glucocorticoid used to treat certain skin diseases, allergies, and rheumatic disorders among others. It is also used to prevent worsening of asthma and COPD. It can be taken in various ways including by mouth, injection i ...

Betamethasone Betamethasone is a corticosteroid, steroid medication. It is used for a number of diseases including rheumatic disorders such as rheumatoid arthritis and systemic lupus erythematosus, skin diseases such as dermatitis and psoriasis, allergic con ...

) applied to the affected area of the skin. Night-time scratching can be reduced with sedatives and antihistamines.

Doxepin Doxepin is a medication falling in the tricyclic antidepressant (TCA) class used to treat major depressive disorder, anxiety disorders, chronic hives, and insomnia. For label updates seFDA index page for NDA 022036/ref> For hives it is a less ...

is often prescribed, as it offers both antihistamine properties and is also effective at reducing the (itch scratch cycle) associated with the obsessive psychosomatic behavioral symptoms.

Gallery

Image:Lichen_simplex_chronicus_1.jpg Image:Lichen_simplex_chronicus_2.jpg Image:Lichen_simplex_chronicus_3.jpg Image:Lichen_simplex_chronicus_4.jpg

References

External links

{{Diseases of the skin and subcutaneous tissue Pruritic skin conditions