3/5/2015 Lichen Simplex Chronicus

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Lichen Simplex Chronicus Author: Daniel J Hogan, MD; Chief Editor: William D James, MD more...

Updated: Jul 31, 2014

BackgroundLichen simplex chronicus (LSC) is thickening of the skin with variable scaling that arises secondary to repetitivescratching or rubbing. Lichen simplex chronicus is not a primary process. Rather, a person senses pruritus in aspecific area of skin (with or without underlying pathology) and causes mechanical trauma to the point oflichenification.

A proposed variant of lichen simplex chronicus is lichen amyloidosis. Lichen amyloidosis is described as lichensimplex chronicus in which the keratinocytes have necrosed and formed keratinocyticderived amyloid in the dermis.The initial insult is pruritus with resultant amyloid formation, rather than the reverse.[1, 2]

PathophysiologyLichen simplex chronicus is found on the skin in regions accessible to scratching. Pruritus provokes rubbing thatproduces clinical lesions, but the underlying pathophysiology is unknown. Some skin types are more prone tolichenification, such as skin that tends toward eczematous conditions (ie, atopic dermatitis, atopic diathesis). Arelationship likely exists between central and peripheral neural tissue and inflammatory cell products in theperception of itch and ensuing changes in lichen simplex chronicus. Emotional tensions in predisposed subjects mayplay a key role in inducing a pruritic sensation, leading to scratching that can become selfperpetuating.[3] Thepossible interplay among primary lesions, psychic factors, and the intensity of pruritus additively influence the extentand severity of lichen simplex chronicus.

A small study looking at lichen simplex chronicus and the use of Pphenylenediamine (PPD)–containing hair dyeshowed clinically relevant improvement in symptoms after discontinuation of PPD exposure, thus providing a basisfor the role of sensitization and contact dermatitis in the etiology of lichen simplex chronicus.

Epidemiology

Frequency

International

Exact frequency in the general population is unknown. In one study, 12% of aging patients with pruritic skin hadlichen simplex chronicus.

Mortality/Morbidity

No mortality occurs as a result of lichen simplex chronicus. Overall, pruritus of lichen simplex chronicus is mild tomoderate, but paroxysms may occur that are relieved by moderatetosevere rubbing and scratching. Pruritus isusually described as much worse during periods of inactivity, usually at bedtime and during the night. Touch andemotional stress also may provoke pruritus, which is relieved by moderatetosevere rubbing and scratching.

Lesions cause little direct morbidity; however, occasionally patients report decreased or interrupted sleep, whichaffects motor and mental functioning.

Lichen simplex chronicus may become secondarily infected after excoriation.

Lichen simplex chronicus is often visible enough to cause patients to seek treatment.

Race

No differences are reported in frequency among races, although prior authors claimed lichen simplex chronicus wasmore common in Asians and African Americans. The appearance of lesions on darker skin sometimes showsfollicular prominence. Secondary pigmentary alterations are also more severe in individuals with darker skin.

Sex

Lichen simplex chronicus is observed more commonly in females than in males. Lichen nuchae is a form of lichensimplex that occurs on the midposterior neck and is observed almost exclusively in women.

Age

Lichen simplex chronicus occurs mostly in midtolate adulthood, with highest prevalence in persons aged 3050years.

Contributor Information and DisclosuresAuthorDaniel J Hogan, MD Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern UniversityCollege of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy ofDermatology, American Contact Dermatitis Society, and Canadian Dermatology Association

Disclosure: Nothing to disclose.

Coauthor(s)Stephen H Mason, MD

Stephen H Mason, MD is a member of the following medical societies: American Academy of Dermatology,American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Society for Dermatologic

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Surgery, Skin Cancer Foundation, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Siobahn M Hruby, MD Internal Medicine Physician, Boys Town National Research Hospital

Siobahn M Hruby, MD is a member of the following medical societies: American College of Physicians andAmerican Medical Association

Disclosure: Nothing to disclose.

Specialty Editor BoardJames J Nordlund, MD Professor Emeritus, Department of Dermatology, University of Cincinnati College ofMedicine

James J Nordlund, MD is a member of the following medical societies: American Academy of Dermatology,Sigma Xi, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University HealthSciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology,Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at SanAntonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology,American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE Medical Director, Clinical Studies Unit, Assistant Professor, Department ofDermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for InvestigativeDermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; GenentechGrant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator;Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; CelgeneConsulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief EditorWilliam D James, MD Paul R Gross Professor of Dermatology, ViceChairman, Residency Program Director,Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology andSociety for Investigative Dermatology

Disclosure: Nothing to disclose.

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