Lichen Simplex ChronicusAlso known as Neurodermaitis Causes• Atopic dermatitis results in a higher probability of developing lichen

simplex chronicus.• Common factors: Insect bites, scars, acne keloidalis nuchae, xerosis,

venous insufficiency, and asteatotic eczema• Psychological factors appear to play a role in the development or

exacerbation of lichen simplex chronicus.– Anxiety has been reported to be more prevalent in patients with lichen

simplex chronicus.– Neurodermatitis is a term formerly used interchangeably with lichen

simplex chronicus, suggesting a role of anxiety or obsession as part of the pathological process of developing lesions.Andrew’s Disease of the skin

Fitzpatrick’s color atlas of dermatologyMedical Therapeutic of Dermatology

Patient’s DataOnset: gradual and insiduousCause: long continued rubing and scratching Sex: females > males Age: mid-to-late adulthood, with highest prevalence in persons aged 30-50 years

Lesions: •Well-circumscribedsolid plaque of lichenification, arising from the confluence of small papules;• scaling is minimal except on lower extremities•Can result to rough, scratched (excoriated), thickened skin surface which may develop increased pigmentation (hyperpigmentation) as seen here on the front part of the foot, just below the leg•fully developed plaque has an outer zone of discrete, brownish papules and a central zone of confluent papules covered with scales.

52 year old femaleObeseDiabeticMultiple pruritic slightly erythematous with hyperpigmented patchesLower abdomen, inguinals and buttocks2 months durationLesions flattened with postinflammatory pigmentationWell demarcated papules vesicles, scales, excoriations at the borders

Lichen Simplex Chronicus PatientsLichenifiction: thickened and leathery, exaggerated skin markings, criss- cross pattern striae in between them a flat topped, shiny smooth , quadrilateral facets

Site of predilection: thickening of the skin:Scalp, Nape of neck, Extensor forearms and elbows, Vulva and scrotum, Upper medial thighs, knees, lower legs, and ankles

Sign and symtoms: paroxysmal pruritus - intermittent - May be intense - Increases with nervous tension, stress less -when patients are active scratching provides temporary relief.

•52 year old female•Obese•Diabetic•Multiple pruritic slightly erythematous with hyperpigmented patches•Lower abdomen, inguinals and buttocks•2 months duration•Lesions flattened with postinflammatory pigmentation•Well demarcated papules vesicles, scales, excoriations at the borders

Lichen Simplex Chronicus

Treatment• aimed at reducing pruritus and minimizing existing lesions because rubbing and

scratching cause lichen simplex chronicus.

• High Potency Topical steroids• are the current treatment of choice because they decrease inflammation and itch while

concurrently softening the hyperkeratosis • Usually applied under plastic or biosynthetic or hydrocolloid dressings overnight or for

continuous 3 to 7 day periods

• Intralesional injection of corticosteroids– Will induce involution most rapidly and is often the therapy of choice

• For infected lesions, a topical or oral antibiotic can be considered

Prurigo Nodularis• Chronic• Etiology: unknown• Contribute factors:

atopic dermatitis anemia hepatic diseases pregnancy

renal failure lymphoproliferative disease photodermatitis

gluten enteropathy stress

insect bites.

Prurigo Nodularis Patients

Gender: Females> malesAge: middle-aged and older persons.

Lesion: •Multiple, firm, excoriated nodules arising at sites of chronically picked or excoriated skin•bilaterally symmetric with nodules that are either stable or increasing in number. •well-defined dome shapes up to 2 cm in diameter•Linear arrangement pea-sized or larger, •Can become verrucous and fissured•Bleeding and scarring

•52 year old female•Obese•Diabetic•Multiple pruritic slightly erythematous with hyperpigmented patches•Lower abdomen, inguinals and buttocks•2 months duration•Lesions flattened with postinflammatory pigmentation•Well demarcated papules vesicles, scales, excoriations at the borders

Prurigo Nodularis Patients

Site of predilection: •Chiefly on the anterior surfaces of the thighs and legs

Sign and symptoms:Lesions slowly evolveParoxysmal pruritus: intermittent, unbearably severe, and relieved only by scratching to the point of damaging skinbilaterally symmetric, with nodules that are either stable or increasing in number

•52 year old female•Obese•Diabetic•Multiple pruritic slightly erythematous with hyperpigmented patches•Lower abdomen, inguinals and buttocks•2 months duration•Lesions flattened with postinflammatory pigmentation•Well demarcated papules vesicles, scales, excoriations at the borders

Prurigo Nodularis

Treatment• Topical, oral, and intralesional corticosteroids

– to decrease inflammation and sense of itching – to soften and smooth out firm nodules

• Menthol, phenol, pramoxine, capsaicin cream,15 vitamin D-3 ointment,16 and topical anesthetics are some other topical agents used to reduce pruritus