3/5/2015

LichenSimplexChronicus

LichenSimplexChronicus
Author:DanielJHogan,MDChiefEditor:WilliamDJames,MDmore...
Updated:Jul31,2014

Background
Lichensimplexchronicus(LSC)isthickeningoftheskinwithvariablescalingthatarisessecondarytorepetitive
scratchingorrubbing.Lichensimplexchronicusisnotaprimaryprocess.Rather,apersonsensespruritusina
specificareaofskin(withorwithoutunderlyingpathology)andcausesmechanicaltraumatothepointof
lichenification.
Aproposedvariantoflichensimplexchronicusislichenamyloidosis.Lichenamyloidosisisdescribedaslichen
simplexchronicusinwhichthekeratinocyteshavenecrosedandformedkeratinocyticderivedamyloidinthedermis.
Theinitialinsultisprurituswithresultantamyloidformation,ratherthanthereverse. [1,2]

Pathophysiology
Lichensimplexchronicusisfoundontheskininregionsaccessibletoscratching.Pruritusprovokesrubbingthat
producesclinicallesions,buttheunderlyingpathophysiologyisunknown.Someskintypesaremoreproneto
lichenification,suchasskinthattendstowardeczematousconditions(ie,atopicdermatitis,atopicdiathesis).A
relationshiplikelyexistsbetweencentralandperipheralneuraltissueandinflammatorycellproductsinthe
perceptionofitchandensuingchangesinlichensimplexchronicus.Emotionaltensionsinpredisposedsubjectsmay
playakeyroleininducingapruriticsensation,leadingtoscratchingthatcanbecomeselfperpetuating. [3]The
possibleinterplayamongprimarylesions,psychicfactors,andtheintensityofpruritusadditivelyinfluencetheextent
andseverityoflichensimplexchronicus.
AsmallstudylookingatlichensimplexchronicusandtheuseofPphenylenediamine(PPD)containinghairdye
showedclinicallyrelevantimprovementinsymptomsafterdiscontinuationofPPDexposure,thusprovidingabasis
fortheroleofsensitizationandcontactdermatitisintheetiologyoflichensimplexchronicus.

Epidemiology
Frequency
International
Exactfrequencyinthegeneralpopulationisunknown.Inonestudy,12%ofagingpatientswithpruriticskinhad
lichensimplexchronicus.

Mortality/Morbidity
Nomortalityoccursasaresultoflichensimplexchronicus.Overall,pruritusoflichensimplexchronicusismildto
moderate,butparoxysmsmayoccurthatarerelievedbymoderatetosevererubbingandscratching.Pruritusis
usuallydescribedasmuchworseduringperiodsofinactivity,usuallyatbedtimeandduringthenight.Touchand
emotionalstressalsomayprovokepruritus,whichisrelievedbymoderatetosevererubbingandscratching.
Lesionscauselittledirectmorbidityhowever,occasionallypatientsreportdecreasedorinterruptedsleep,which
affectsmotorandmentalfunctioning.
Lichensimplexchronicusmaybecomesecondarilyinfectedafterexcoriation.
Lichensimplexchronicusisoftenvisibleenoughtocausepatientstoseektreatment.

Race
Nodifferencesarereportedinfrequencyamongraces,althoughpriorauthorsclaimedlichensimplexchronicuswas
morecommoninAsiansandAfricanAmericans.Theappearanceoflesionsondarkerskinsometimesshows
follicularprominence.Secondarypigmentaryalterationsarealsomoresevereinindividualswithdarkerskin.

Sex
Lichensimplexchronicusisobservedmorecommonlyinfemalesthaninmales.Lichennuchaeisaformoflichen
simplexthatoccursonthemidposteriorneckandisobservedalmostexclusivelyinwomen.

Age
Lichensimplexchronicusoccursmostlyinmidtolateadulthood,withhighestprevalenceinpersonsaged3050
years.

ContributorInformationandDisclosures
Author
DanielJHogan,MDClinicalProfessorofInternalMedicine(Dermatology),NovaSoutheasternUniversity
CollegeofOsteopathicMedicineInvestigator,HillTopResearch,FloridaResearchCenter
DanielJHogan,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,AmericanAcademyof
Dermatology,AmericanContactDermatitisSociety,andCanadianDermatologyAssociation
Disclosure:Nothingtodisclose.
Coauthor(s)
StephenHMason,MD
StephenHMason,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,
AmericanCollegeofMohsMicrographicSurgeryandCutaneousOncology,AmericanSocietyforDermatologic

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LichenSimplexChronicus

Surgery,SkinCancerFoundation,andWomen'sDermatologicSociety
Disclosure:Nothingtodisclose.
SiobahnMHruby,MDInternalMedicinePhysician,BoysTownNationalResearchHospital
SiobahnMHruby,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofPhysiciansand
AmericanMedicalAssociation
Disclosure:Nothingtodisclose.
SpecialtyEditorBoard
JamesJNordlund,MDProfessorEmeritus,DepartmentofDermatology,UniversityofCincinnatiCollegeof
Medicine
JamesJNordlund,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,
SigmaXi,andSocietyforInvestigativeDermatology
Disclosure:Nothingtodisclose.
RichardPVinson,MDAssistantClinicalProfessor,DepartmentofDermatology,TexasTechUniversityHealth
SciencesCenter,PaulLFosterSchoolofMedicineConsultingStaff,MountainViewDermatology,PA
RichardPVinson,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,
AssociationofMilitaryDermatologists,TexasDermatologicalSociety,andTexasMedicalAssociation
Disclosure:Nothingtodisclose.
JeffreyMeffert,MDAssistantClinicalProfessorofDermatology,UniversityofTexasSchoolofMedicineatSan
Antonio
JeffreyMeffert,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatology,
AmericanMedicalAssociation,AssociationofMilitaryDermatologists,andTexasDermatologicalSociety
Disclosure:Nothingtodisclose.
JoelMGelfand,MD,MSCEMedicalDirector,ClinicalStudiesUnit,AssistantProfessor,Departmentof
Dermatology,AssociateScholar,CenterforClinicalEpidemiologyandBiostatistics,UniversityofPennsylvania
JoelMGelfand,MD,MSCEisamemberofthefollowingmedicalsocieties:SocietyforInvestigative
Dermatology
Disclosure:AMGENConsultingfeeConsultingAMGENGrant/researchfundsInvestigatorGenentech
Grant/researchfundsinvestigatorCentocorConsultingfeeConsultingAbbottGrant/researchfundsinvestigator
AbbottConsultingfeeConsultingNovartisinvestigatorPfizerGrant/researchfundsinvestigatorCelgene
ConsultingfeeDMCChairNIAMSandNHLBIGrant/researchfundsinvestigator
ChiefEditor
WilliamDJames,MDPaulRGrossProfessorofDermatology,ViceChairman,ResidencyProgramDirector,
DepartmentofDermatology,UniversityofPennsylvaniaSchoolofMedicine
WilliamDJames,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofDermatologyand
SocietyforInvestigativeDermatology
Disclosure:Nothingtodisclose.

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