Lichen Simplex Chronicus
Vulvar lichen simplex chronicus is a common dermatosis characterized by skin lichenification following excessive scratching. It is the end stage of an itch-scratch-itch cycle. The skin is thickened, erythematous, pale, or pigmented, with accentuated marki
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Despoina Mortaki and Alexander Mortakis
17.1 Definition and Epidemiology
17.2 Causes and Pathogenesis
Lichen simplex chronicus (LSC) is an acquired severely itching chronic dermatosis characterized by a nonscarring process of epidermal thickening that develops as a result of repeated rubbing and scratching (the end stage of the itch-scratch-itch cycle). Histologically there is acanthosis with a prominent superficial dermal inflammatory cell infiltrate [1]. Cases previously described with the terms squamous cell hyperplasia, neurodermatitis, and hyperplastic dystrophy are included now under the term lichen simplex chronicus [2, 3]. LSC papules and plaques of thickened lichenified skin can be found on the vulva and the perianal area, but LSC is a common cutaneous disorder occurring also on the pubis, neck, ankles, scalp, and extensor forearms [4]. Vulvar LSC occurs mostly in mid-to-late adulthood, with highest prevalence in persons aged 30–50 years. It is a common disease, although exact incidence and prevalence figures have not been determined. Exact prevalence is unknown, but it is estimated to occur in approximately 0.5–1% of the western European and American populations [5].
Any disorder that causes itch can lead to the development of LSC. The intense, chronic itching leads the patient to repetitively rub and scratch the affected area. When a patient repetitively scratches or rubs a pruritic area of skin over time, lichenification will develop. Lichen simplex chronicus is the end stage of an itch- scratch- itch cycle. Some skin types are more prone to lichenification, such as skin that tends toward eczematous conditions (i.e., atopic dermatitis, atopic diathesis). There is an altered skin barrier. Up to 75% of patients with LSC have a personal or family history of allergic rhinitis, asthma, or atopic dermatitis. Other studies demonstrate an incidence of between 20% and >90% [5–7]. The itch-scratch cycle, with habitual scratching, is a major component of atopic dermatitis. Disruption of the epidermal barrier, as a result of scratching, allows stimulation of type C non-myelinated nerve endings that convey itch and pain to the CNS, as well as providing the initial driving stimulus for LSC [8]. LSC can be a primary dermatosis (the process arising de novo from normal skin), or secondary, presenting as a reaction to another vulvar disease (superimposed on an underlying disorder such as lichen sclerosus, psoriasis, etc.). In primary LSC, the skin is normal at the outset. Irritation from any number of originating causes, yeast infection, reaction to a moisturizer, too-tight clothing, over-washing, panty liners,
D. Mortaki University Hospital “A. Syggros” for Skin and Venereal Diseases, Athens, Greece A. Mortakis (*) “IASO” Maternity Hospital, Athens, Greece e-mail: [email protected]
© Springer International Publishing AG, part of Springer Nature 2019 J. Bornstein (ed.), Vulvar Disease, https://doi.org/10.1007/978-3-319-61621-6_17
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sweat, urine, etc., starts the process off. Scratching seems mandat
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