Lichen Simplex Chronicus

Today, we’re going to discuss about Lichen Simplex Chronicus abbreviated as LSC or sometimes also called as Circumscribed Neurodermatitis.

So let us discuss what is LSC, what causes it and how can it be treated.

In some people, areas of skin becoms thick and black due to excessive itching and may lead to ulcer. This is called LSC.

Now, why does this occur?

Well, no exact cause for this is known as of now. However, it if often found in people with high levels of stress and anxiety.

The problem with LSC is that it is known to occur in both healthy and diseased skin. Diseased skin meaning skin with Fungal infection such as

Tinea Corporis Atopic Eczema Seborrheic dermatitis etc.

There are many such skin diseases in which the skin starts to itch excessively. This causes tge skin to become thick and black. The skin creases and lines become unduly prominent. This marks the beginning of LSC disease.

Where is its most common site of occurrence?

1. Back of the neck
2. Ankle
3. Wrist
4. In the private parts of both genders, such as Vulva in females and Scrotum in males, and in the anus.

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The problems faced by the patient

1. Paroxysmal or Severe itching which may cause skin ulceration, wounds or infection
2. Appearance – Skin becomes thick and black with prominent skin creases.

This is called Lichenification of skin, hence the name Lichen Simplex Chronicus. Chronicus means long term, that is, the symptoms may last for a long duration in an individual and is also seen to relapse, even after treatment.

DIAGNOSIS

Diagnosis of LSC is done by general Clinical examination of the symptoms.

However there are other skin diseases with similar symptoms such as :-

• Localised or Hypertrophic Psoriasis
• Lichen Planus Hypertrophicus
• Seborrheic dermatitis
• Chronic contact dermatitis

In case of the diagnosis not being accurate via clinical examination, Skin Biopsy is used to diagnose LSC.

TREATMENT

1. Use moisturizer frequently to prevent dryness of skin.
2. Many steroid ointments can be prescribed for treatment as follows :-

(i) Topical High potent Corticosteroid – such as Clobetasol, Halobetsol etc.

(ii) Topical Medium potent Corticosteroid – such as Mometasone, can be used with application of plaster for longer duration of effect.

*Never use steroid cream for a long period without tge advice of a dermatologist, as it may cause Thinning and Atrophy of the skin.

3. Other Topical creams such as Topical Doxepin, Calcipotrial, Tacrolimus, Pimecrolimus can be used for treatment. However, they are not as effective as the topical steroid ointments.

4. Initraleaional steroid injection can be used for treatment as well, if treatment using application of cream and ointments is ineffective.

However, the injection has to be administered by a professional Dermatologist only as there can be risk of appearance of white patches on skin, Skin atrophy or Pitting of the skin.

5. Advanced therapy includes Botox Therapy, which has been found to be effective in many cases but is still not considered as a full proof method of treatment.

Whatever the treatment might be, it should be kept in mind that LSC is a chronic diseas and is often seen to relapse in many patients. Thus, along with Cream / Ointments or injections, patients are sometimes given Oral medications which include Anti – histamines (to reduce itching) or in severe cases Oral steroids are given, but in small doses.

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Blog by: Dr. Uttam Kumar Lenka, Consultant Dermatologist. Kolkata.