Lichen simplex chronicus is a chronic inflammatory skin disease that presents in adulthood. It most commonly affects people in their early 20s to 60s, and women are significantly more susceptible than men. The following article discusses in more detail the causes, symptoms, symptoms, diagnosis, and course of the disease, as well as treatment options through various therapies.
What is lichen simplex chronicus?
Lichen simplex chronicus is a chronic, itchy inflammation of the upper layers of the skin that occurs in episodes. It is one of the chronic eczematous skin diseases and also often appears under the name neurodermatitis cirumscripta, lichen chronicus vidal, or Vidal disease.
Causes
Exact causes are currently not fully understood. In most cases, the eczematous inflammation of the skin occurs as a result of a drug reaction or allergy. However, investigations also point to itch-triggering systemic diseases due to diabetes mellitus, liver diseases, gastrointestinal disorders, renal insufficiency or other underlying diseases, as well as environmental factors due to cold, heat, air pollution or unspecific irritants. Furthermore, psychosomatic factors play a significant role as triggers. Until now, it was assumed that people who are exposed to psychological strain and great stress over a longer period of time are particularly susceptible to lichen simplex chronicus. A clinical study then investigated the period of relapses in which the disease with its symptoms was particularly active. Periods of relative relaxation and inactivity also emerged. Accordingly, it is clear that the involuntary scratching mechanism is also present during aspects distracting from itching.
Symptoms, complaints, and signs
Lichen simplex chronicus is manifested by incessant severe itching that is not relieved even by scratching, but provokes further scratching attacks. This results in even more severe itching. Many sufferers are no longer aware of this vicious circle of itching and scratching. They act as if in a trance and sometimes scratch themselves for no apparent reason. The disease can occur anywhere on the body. Disorders caused by lichen simplex chronicus show up preferably on the chest and neck, arms, legs, back of the knees, scalp and neck, but also in the genital area. Situations of anxiety or depression favor the reaction of excessive scratching and the skin condition worsens. In the early stages, the skin still has a normal appearance. It begins to itch and, as it progresses, becomes dry and scaly. Due to rubbing and scratching, strip-like changes develop on the skin, which increase in size. Pea-sized, reddish-brown to grayish-brown papules form and multiply on the area leathery thickening of the skin (lichenification) as mostly scratched lichen-like nodules.
Diagnosis and course of the disease
To diagnose lichen simplex chronicus with certainty, skin diseases that have similar symptoms must be excluded. These include, for example, allergic contact dermatitis, atopic eczema, or lichen ruber planus. However, if the itching occurs in the vaginal or anal area, fungi, local discharge, warts, psoriasis and contact dermatitis may be responsible. The physician will initiate the necessary investigations. Already during the anamnesis, the physician must be informed of all known details about family circumstances, diseases or existing psychological conditions. In addition to differential diagnosis in the medical field, histological findings usually provide clarity about the actual presence of lichen simplex chronicus. A tissue sample is taken from the affected area by biopsy and analyzed histologically. The diagnosis in patients with severe symptoms can be recognized without difficulty from the chronic course and the inflammatory manifestations of the typical lichen nodules.
Complications
Due to lichen simplex chronicus, in most cases, affected individuals suffer from very severe itching. Usually, this itching is only intensified if the affected person scratches the respective area. The quality of life of patients is considerably reduced by lichen simplex chronicus. Likewise, this disease can lead to psychological discomfort, as the itching is permanent.Sometimes redness appears on the skin. Especially in the area of the head and face, these complaints are very unpleasant and can also lead to inferiority complexes or reduced self-esteem. Furthermore, it is not uncommon for depression to occur. The skin is significantly damaged by Lichen simplex chronicus and appears dry and scaly. Furthermore, this disease leads to the formation of papules and pustules that can cover the skin in various places. Likewise, the disease can negatively affect the patient’s sleep, leading to irritability. The treatment of this disease is carried out with the help of medications. It usually leads to a positive course of the disease. No particular complications occur. Lichen simplex chronicus also does not usually reduce or affect the patient’s life expectancy.
When should you see a doctor?
If the affected person suffers from severe persistent itching of the skin, he should see a doctor. If there is no relief from the symptoms despite scratching the affected areas of the body, this is a feature and an indication of lichen simplex chronicus. A visit to the doctor is necessary before further illness or complications occur. Pathogens can enter the organism through the existing wounds and cause further diseases. A visit to the doctor is therefore necessary as soon as the affected person is unable to provide adequate wound care. In case of further changes of the usual skin appearance or a spreading of the existing complaints, a doctor is needed. If pus forms, the affected person is at risk of blood poisoning. A visit to the doctor is necessary to prevent a life-threatening condition. In case of fever, pain or sweating, a doctor should be consulted immediately. If diffuse anxiety arises as a result of the symptoms or if the affected person experiences mood swings, a visit to the doctor is advisable. Depressive behavior is considered a cause for concern and must be clarified. A doctor should be consulted as soon as the behavioral problems persist for several weeks or months. If dry or scaly skin gradually develops, a visit to the doctor should be made. If poplars or other swellings form on the skin, clarification of the skin changes by a physician is advised.
Treatment and therapy
Treatment of the disease often proves to be very complex, which in itself is an additional and frustrating burden for affected individuals. However, the goal of treatment is always to minimize itching and, as a consequence, to eliminate eczema. General measures for local application of moisturizer, corticosteroids or a change in lifestyle help here. In exceptional cases, mild sleeping pills have a supportive effect to curb the annoying itching or an antihistamine, which is taken before going to bed. This prevents the threat of sleep disturbances or sleep deprivation, which are not infrequently also triggers of psychological suffering. In the case of psychological stress as a result of lichen simplex chronicus, it is advisable to consult a psychologist before starting clinical therapy in order to identify possible psychological causes. Itching in the genital area is particularly unpleasant. Here, regular applications of sitz baths with tanning additives or applications with ointments based on coal tar as well as pastes with zinc oxide are helpful and can provide considerable relief. Curative results in the treatment of skin diseases are often achieved by climatic therapies. It is said that the greater the difference in climate, the more favorable are the curative effects for the clinical picture! Accordingly, a stay in the low mountain range is less successful than conducting therapy in the high mountains or directly on the North Sea, where the ultraviolet light is particularly intense.
Outlook and prognosis
The prognosis of skin lesions is tied to the causative disorder. In a large number of patients, an unfavorable course of the disease and subsequent freedom from symptoms can be documented. If the skin inflammations are triggered by an intolerance, recovery may already occur within a short time. The causative agent must be found and should be avoided in the future. Often it is an intolerance due to the administration of medicines. Alternative preparations are prescribed so that the underlying disease can continue to be treated.If lichen simplex chronicus sets in due to strong emotional stress, the affected person can achieve an improvement in his or her psychological state on his or her own or with the support of a therapist. Stressors must be minimized and the way of life should be optimized. In many cases, a fundamental improvement in the quality of life also leads to relief of the skin complaints. If the affected person suffers from a chronic disease or organic disorder, the prognosis is usually worse. The course of this underlying disease is usually characterized by an increase in symptoms or irreversible damage to the organism. Regardless of the present cause of the disease, it has been shown that the overall complaints can be reduced if the joy of life and well-being have increased. Therefore, the emotional aspect seems to be of particular importance in the prognosis.
Prevention
The chronic and recurrent disease lichen simplex chronicus is usually a lifelong companion for affected individuals. However, the effects of the symptoms can be positively influenced by medical means. In daily life, the patient should always take care not to irritate the affected skin areas unnecessarily by not using aggressive cosmetic products or wearing scratchy clothing. Stays in the fresh air and sun exposure in moderation, on the other hand, are recommended for relief or faster healing.
Aftercare
The measures of an aftercare usually depend very much on the severity of the disease, so that thereby usually no general prediction can be made. Various symptoms and complications can occur with lichen simplex chronicus. Most patients suffer from severe itching of the skin and significantly reduced aesthetics due to lichen simplex chronicus. Follow-up care aims to manage the condition well and strive to improve the quality of life. Signs of depression or other psychological upsets should be clarified by a psychological expert and, if necessary, cured with therapy. A self-healing of the disease can not occur, so that regular visits to a doctor will always be necessary. Contact with other sufferers can sometimes promote an exchange of information and the certainty of not being alone with one’s fate. However, lichen simplex chronicus does not negatively affect or reduce the life expectancy of the affected person.
What you can do yourself
Patients with lichen simplex chronicus suffer a severe reduction in their usual quality of life due to the itching and skin damage caused by scratching. Therefore, the most important self-help measure for those affected is to become aware of the disease and make the decision to seek medical treatment. This is because numerous patients with the condition scratch themselves in a trance-like manner, intensifying the vicious circle of itching and skin lesions more and more. The dermatologist prescribes drugs and ointments against the symptoms, which usually have to be applied daily by the patient. As long as the treatment of the disease is not yet completed and visible changes appear on the skin, the affected persons often suffer from shame because of the cosmetic flaw. In order to speed up the healing process, the affected person follows the doctor’s instructions regarding personal hygiene, use of cosmetics and clothing, which should be made of skin-compatible fibers if possible. Central to the success of the treatment of the disease is also to find the often psychological trigger for the itching. Here, too, the most important role is played by the patients themselves, who must first admit psychological discomfort to themselves. They then turn to a psychologist to work through the relevant problems and restore emotional balance.
