What is Lichen Simplex Chronicus?
Lichen simplex chronicus is a typical type of continuous skin condition, known as chronic neurodermatitis, featuring dry, patchy, and thick scaly areas of skin. This condition usually comes from frequent scratching or rubbing a specific skin area, leading to thickening of the upper layer of the skin, known as the epidermis. The cause of this skin disorder could be an original symptom, potentially linked to psychological factors, or it could result from other skin conditions such as eczema or psoriasis. These patches of skin happen because of itchy skin diseases that often come about from mental stress.
This condition usually impacts particular sections of the body. Even though lichen simplex chronicus is usually not a dangerous skin disorder, continuous itching can cause infections, changes in the growth and division of skin cells known as keratinocytes, and inconsistent changes to the skin’s surface layer. However, the transformation of the affected skin areas into cancerous cells is rare.
What Causes Lichen Simplex Chronicus?
Lichen simplex chronicus, a skin condition, has been associated with emotional stress in various studies. This stress tends to induce a recurring itch-scratch cycle where people repeatedly scratch certain areas due to emotional disturbances or an intense need to relieve an itch. This constant scratching can result in the formation of thick skin patches known as plaques.
Usually, the areas that are most prone to this condition are easy to reach spots on the body; like the scalp, head, neck, hands, arms, and genitals.
Interestingly, the emotional stress and the resulting skin irritation form a cycle; the more stressed the person gets, the more they scratch. This continually creates plaques that cause further stress, leading to chronic itching, changes in skin color, and at times, the spreading of patches over larger areas.
Although the condition is predominantly itchy, it could arise from issues with the skin’s protective barrier. It could also be secondary to other skin conditions such as xerosis (dry skin), psoriasis (red, scaly patches on the skin), atopy (tendency to develop allergic diseases), or others.
Risk Factors and Frequency for Lichen Simplex Chronicus
Lichen simplex chronicus is estimated to affect roughly 12% of the population. It is predominantly seen in middle-to-late adulthood, typically peaking between the ages of 30 and 50. This could be linked to the higher levels of stress individuals experience during this phase of their lives. Interestingly, this condition is more common in females, with a female-to-male ratio of 2:1.
Signs and Symptoms of Lichen Simplex Chronicus
Lichen simplex chronicus is a skin condition that usually affects easily accessible body parts like the head, neck, arms, scalp, and genitals. This condition often starts with a single or multiple itchy spots. Over time, repeated scratching can lead to the formation of plaques, which are thick, possibly discolored areas on the skin.
These plaques can be different colors, from various shades of yellow to deep reddish-brown, especially in the center of the lesion. As the lesion age, the color may change, becoming lighter in the center and darker at the surrounding areas. These plaques can differ in size but typically range from 3 by 6 centimeters to 6 by 10 centimeters.
Testing for Lichen Simplex Chronicus
If your doctor suspects that you may have lichen simplex chronicus, a skin condition characterized by thick, itchy patches of skin, several different tests and examinations may be involved in the diagnosis. These can include:
– A physical exam: Your doctor would look at your skin to check for any visual signs of the condition.
– A complete medical history: Your doctor may ask you about your past health problems and any medications you’re currently taking. This is to help them understand if anything in your medical background might be contributing to the condition.
– Dermoscopy: This is a test where a doctor uses a device called a dermatoscope to get a closer look at your skin. It can help them see details that might not be visible to the naked eye.
– Self-reported symptoms: Your doctor may ask about any symptoms you’re experiencing, such as itching or skin discomfort.
– Patch testing: This test involves applying small patches with different substances to your skin to check for allergies. It can help identify whether contact dermatitis (a type of skin inflammation caused by contact with specific substances) is causing your symptoms.
If the lichen simplex chronicus is affecting your genital area, the doctor may also do a potassium hydroxide examination and fungal cultures. These tests help rule out other diseases such as tinea cruris (also known as jock itch) or candidiasis (a fungal infection).
In some cases, a small piece of skin (biopsy) might be removed for further testing. This helps exclude other conditions like psoriasis or a type of skin cancer called mycosis fungoides.
Lastly, a blood test could be done. Sometimes people with this condition have higher levels of something called immunoglobulin E in their blood. Immunoglobulin E is a type of protein that the immune system makes in response to allergies, so a blood test might help support the diagnosis.
Treatment Options for Lichen Simplex Chronicus
Lichen simplex chronicus is a skin condition that can be managed with several treatments. One method is to cover the area. Topical anti-inflammatory treatments, like strong corticosteroids, can help reduce inflammation. These are typically applied for 3 weeks at a time if the skin patches are thick. Moisturizers help to soothe the skin, while antibiotics may be needed if a skin infection is suspected or present, particularly when drugs that suppress the immune system are being used. Antihistamines, which are medicines that block allergic reactions, may also help.
Two other treatments that might be used include doxepin, a medication usually used to treat depression and anxiety, and capsaicin, a substance derived from chili peppers that can help reduce itching and inflammation. A small clinical trial has suggested that a topical mix of aspirin and dichloromethane, a chemical often used as a solvent, may provide relief to people who don’t respond to other creams or ointments.
Other research has found that certain immune-modifying drugs, namely tacrolimus and pimecrolimus, may also be effective. In more severe cases, light therapy (using UVA or UVB light) or photochemotherapy (a combination of light therapy and medication that makes the skin more sensitive to light) might be used. It’s important to note that these treatments shouldn’t be used on genital skin.
Because lichen simplex chronicus can be related to stress or psychological factors, psychological treatments like counseling and anti-anxiety medications can also be beneficial. Recent research suggests that botulinum toxin injections, commonly known as Botox, may be a possible treatment for patients who haven’t found relief with other options.
In terms of surgical options, ‘cryosurgery’, where the patch of skin is frozen off, can be effective. If all other treatments fail and the skin condition persists, a surgery done to remove small areas of affected skin may be considered.
What else can Lichen Simplex Chronicus be?
Doctors need to rule out several conditions that might be confused with the condition they’re trying to diagnose. These conditions include:
- Psoriasis
- Atopic dermatitis (a kind of skin inflammation also known as eczema)
- Lichen planus (a skin rash triggered by the immune system)
- Contact dermatitis (a skin rash caused by contact with a certain substance)
- Mycosis fungoides (a type of skin lymphoma, which is a kind of cancer)
- Fungal infections (caused by fungus)
- Squamous cell carcinoma (a type of skin cancer)
What to expect with Lichen Simplex Chronicus
Lichen simplex chronicus often gets better with proper treatment. However, some cases may continue for an extended period, particularly when it affects the genital area.
