Lichen Simplex Chronicus

“Other diagnosis for itching vulva/scrotum”

Lichen simplex chronicus is also known as neurodermatitis. It is a skin condition which appears as scaly, thick, hyperpigmented, dry skin caused by chronic pruritus with scratching. This condition more commonly occurred in women compared to men with ratio 2:1 and middle to late age group between 35 to 50 years old. The areas which are self accessible on the body surface such as head, hands, arm, neck, scalp and genitals (vulva/scrotum). Some studies show that this condition is related to emotional factors which result in repetitive itching in consequence with intense scratching the area consistently due to emotional disturbance.

The prevalence of 12 % in the population was estimated to occur. The pathophysiology for the cause is still unclear. Factors contributing to this are depression, anxiety, obsessive-compulsive disorder or other emotional related stressors can lead to scratching.

Clinical Features:

  • Itching
  • Plaques and thicken (discoloured lesion may occur after recurrent scratching)
  • Colour of skin: different shades of yellow or deep reddish brown
  • Dry and scaly surface
  • Broken off hairs
  • Leathery induration

Causes:

  • Various eczema (atopic eczema, contact dermatitis/eczema, venous eczema)
  • Psoriasis
  • Lichen planus
  • Insect bite
  • Fungal infection
  • Neuropathy
  • Squamous cell carcinoma
  • Mycosis fungoides

Test Required:

  • Skin scrapings (possible fungal – candidiasis, tinea)
  • Skin biopsy
  • In absence of skin infection/condition, should consider neuropathy (MRI, CT, X rays of spine, Nerve conduction studies)

Treatment:

  • High potent topical steroid cream until the plaque resolved
  • Topical emollients /moisturizers to prevent the dryness
  • Antibiotics /antifungal medication if high likely or present
  • Antihistamine to suppress the allergic modulators
  • Steroid injections
  • Phototherapy with UVA exposure/ photochemotherapy for severe cases
  • Psychological treatments (antipsychotic medications)
  • Topical mix of aspirin/dichloromethane for those not responding to topical steroids
  • Surgical: cryosurgery (* if persistent after all the treatment above)

Prognosis:

Improves with treatment but in some cases may be persistent especially vulva/scrotum.

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