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Lichen Simplex Chronicus: Causes, Symptoms, Diagnosis, Treatment, and Prevention

The skin ailment known as lichen simplex chronicus is brought on by repeated scratching or rubbing of the skin, which causes the afflicted regions to thicken, darken, and scar. It can raise the risk of infections and skin cancer in addition to causing excruciating pain, irritation, and itching. Although it can occur anywhere on the body, lichen simplex chronicus most commonly affects the arms, legs, neck, and genitalia. Although the precise etiology of lichen simplex chronicus is unknown, stress, worry, or other skin or psychological diseases may be connected to the condition. Although lichen simplex chronicus cannot be cured, therapy can lessen symptoms and avoid consequences. We'll talk about lichen simplex chronicus causes, symptoms, diagnosis, treatment, and prevention in this blog article.

Causes of Lichen Simplex Chronicus

Lichen simplex chronicus is the skin's response to a prolonged physical insult or trauma rather than a basic illness. Skin becomes thicker, darker, and scarred as a result of repetitive scratching or rubbing, which also damages skin cells and induces inflammation. We refer to this process as lichenification. A vicious cycle is created when the thicker skin becomes more sensitive and irritating, which leads to further rubbing and scratching. The scratch-itch cycle is another name for this cycle.

The reason why some people develop lichen simplex chronicus is not clear, but it may involve several factors, such as:

• Stress or anxiety, which can trigger or worsen the itching and scratching behavior, and affect the skin’s immune system and healing ability.

• Skin disorders, such as eczema, psoriasis, or fungal infections, which can cause itching and inflammation of the skin, and predispose the skin to lichenification.

• Psychological disorders, such as depression, obsessive-compulsive disorder, or personality disorders, which can affect the mood, coping skills, and self-esteem of the person, and influence the scratching and rubbing behavior.

• Environmental factors, such as dry or cold weather, harsh chemicals, or tight clothing, which can irritate or dry out the skin, and make it more prone to itching and scratching.

Symptoms of Lichen Simplex Chronicus

The appearance of thicker, darker, scarred skin patches that are incredibly irritating and even painful is the primary sign of lichen simplex chronicus. Although the patches can differ in size, shape, and location, they are typically seen in places that are readily scraped or rubbed, such the following:

• Neck

• Scalp

• Arms

• Legs

• Genitals

The patches may have the following characteristics:

• They may have a leathery, rough, or scaly texture, depending on the degree of lichenification.

• They may have a red, purple, or brown color, depending on the skin tone and the amount of blood flow to the area.

• They may have cracks, fissures, or ulcers, which can bleed or become infected.

• They may have increased or decreased sensation, depending on the nerve damage caused by the scratching or rubbing.

Other symptoms that may accompany lichen simplex chronicus are:

• Anxiety or depression, due to the distress and embarrassment caused by the condition, and the difficulty in controlling the scratching and rubbing behavior.

• Sleep disturbance, due to the itching and pain that interfere with falling asleep or staying asleep.

• Impaired quality of life, due to the physical, emotional, and social impact of the condition, and the limitations in daily activities and relationships.

Diagnosis of Lichen Simplex Chronicus

Lichen simplex chronicus can be diagnosed by a dermatologist, who is a doctor who specializes in skin conditions. The diagnosis may involve:

• Medical history and physical examination, which include asking about the symptoms, the duration and frequency of the symptoms, the personal and family history of skin or psychological disorders, and the medications or treatments used. The dermatologist will also examine the affected skin and look for signs of lichen simplex chronicus, such as thickening, darkening, or scarring.

• Skin biopsy, which involves taking a small sample of skin from the affected area and sending it to a laboratory for microscopic analysis. A skin biopsy can confirm the diagnosis of lichen simplex chronicus and rule out other conditions that may cause similar symptoms, such as skin cancer or infection.

• Blood tests, which can check for the presence of infections, such as fungal or bacterial infections, or other diseases, such as diabetes or thyroid disorders, that may cause itching or affect the skin’s healing ability.

Treatment of Lichen Simplex Chronicus

The treatment of lichen simplex chronicus aims to break the scratch-itch cycle, relieve the symptoms, and prevent complications. The treatment may include:

• Medications, which can help reduce the inflammation, itching, and pain of the affected skin. The most common medications used for lichen simplex chronicus are:

• Topical corticosteroids are anti-inflammatory creams or ointments that are administered once or twice a day for several weeks or months on the afflicted skin. Examples of these medications are hydrocortisone and betamethasone. Topical corticosteroids can help stop further damage and scarring from occurring as well as lessen skin edema, redness, and irritation. But they can also result in systemic absorption, which might impact the adrenal glands, blood pressure, or blood sugar levels, or adverse effects including skin thinning, bruising, or discolouration. As a result, they have to be used cautiously and under a dermatologist's supervision.

• Antihistamines, such as diphenhydramine or cetirizine, are oral medications that are taken once or twice a day for several weeks or months. They inhibit the effects of histamine, a molecule that causes itching and allergic responses. Antihistamines might lessen rubbing and scratching behavior as well as ease irritation. On the other hand, they may also result in adverse consequences including dry mouth, sleepiness, or impaired eyesight. As such, they ought to be used cautiously and under a physician's supervision.

• Antibiotics, such as erythromycin or penicillin, are liquids or tablets that are taken orally over a period of days or weeks in order to either kill or inhibit the development of germs. Antibiotics can be used to treat or prevent infections on the afflicted skin, particularly in cases when cracks, fissures, or ulcers are present. On the other hand, adverse symptoms including nausea and diarrhea may also result from them. As a result, you should only use them as directed by a physician.

• Therapy, which can help address the psychological and behavioral aspects of the condition. The most common therapies used for lichen simplex chronicus are:

• Cognitive-behavioral therapy (CBT), which is a type of psychotherapy that helps the person identify and change the negative thoughts and emotions that trigger or worsen the itching and scratching behavior, and develop coping skills and strategies to deal with the stress, anxiety, or depression caused by the condition. CBT can help the person break the scratch-itch cycle and improve the quality of life.

• Habit reversal training (HRT), which is a type of behavioral therapy that helps the person recognize and monitor the scratching and rubbing behavior, and replace it with a more positive or neutral behavior, such as clenching the fists, squeezing a ball, or applying a moisturizer. HRT can help the person reduce the frequency and intensity of the scratching and rubbing behavior and prevent further damage and scarring of the skin.

• Surgery may be necessary to remove or restore the damaged skin, particularly if it is very thick, dark, or scarred, or if it affects a bodily part—such as the genitalia or the anus—and impairs its ability to function. A knife, a laser, or a skin transplant may be used during surgery to remove or replace the injured skin. Surgery can enhance the skin's look and functionality, but it can also have unfavorable side effects including bleeding, infection, or scarring. As such, it ought to be reserved for extreme circumstances and should only be suggested by a dermatologist.

Prevention of Lichen Simplex Chronicus

There is no sure way to prevent lichen simplex chronicus, but some steps that may help reduce the risk or recurrence of the condition are:

• Avoiding or treating any skin disorders, such as eczema, psoriasis, or fungal infections, that may cause itching and inflammation of the skin, and predispose the skin to lichenification.

• Avoiding or minimizing any environmental factors, such as dry or cold weather, harsh chemicals, or tight clothing, that may irritate or dry out the skin, and make it more prone to itching and scratching.

• Applying moisturizers or emollients, such as petroleum jelly or lanolin, to the skin to keep it hydrated and protected, and prevent it from cracking or bleeding.

• Keeping the nails short and clean, and wearing gloves or mittens at night, to prevent scratching or injuring the skin.

• Seeking professional help for any psychological or behavioral issues, such as stress, anxiety, or depression, that may trigger or worsen the itching and scratching behavior, and affect the skin’s immune system and healing ability.