Lichen Simplex Explained #51

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Hi everyone and hope you enjoy this episode on lichen simplex.
The term ‘lichen’ is Latin and means a plant-like moss covering trees. Lichen simplex describes a response to the skin being repeatedly scratched or rubbed over a long period of time (also called lichen simplex chronicus). A single or multiple plaque (thickened area of skin) of rough skin forms, with increased markings and sometimes little bumps around the hair follicles.
Lichen simplex can affect any age group, but is most common in adults and is unusual in children.
Lichen simplex can be sore, but is more often very itchy. This itch usually comes in bursts, may be worse at times of rest and at night. The itch then prompts scratching, which in turn aggravates the skin (called itch-scratch cycle) and may lead to superficial skin infection.
Lichen simplex has increased skin markings called lichenification and can show little bumps around hair follicles. The skin may feel dry, thickened and rough to the touch. The affected skin often looks scaly, red and over time can become more pigmented than the surrounding skin, especially in darker skin types.
Areas more commonly affected by lichen simplex are those within easy reach of scratching, for example the neck, the front of the legs, outer arms and genitals.
The itch-scratch cycle needs to be broken in lichen simplex. Any specific underlying problem,e.g. a fungal infection or contact allergy, needs to be treated.
Treatment of lichen simplex may require a combination of ointments, creams and antihistamine tablets. Soap, shower gel or bubble bath should be avoided. A soap substitute (any bland cream or ointment) should be applied prior to a bath or shower and then washed off to clean the skin. Frequent application of moisturizers is helpful.
Covering the affected skin with a dressing, plaster or bandage (occlusion) may help relieve the itching and reduce the damage caused by scratching. This can also be achieved with frequent application of bland ointments.
Treatment of skin inflammation:
Repeated courses of strong (e.g. betamethasone) or super-strong (e.g. clobetasol propionate) steroid ointment or cream, applied once a day, are often required. Steroid impregnated tape can be useful, as it also covers the affected area. Sometimes, steroid injections (e.g. triamcinolone) into the plaque of lichen simplex reduce both the itch and thickness.
Please see more information on the British Association of Dermatologists (BAD): www.bad.org.uk/
If badly affected you will need to see a dermatologist.
I hope you enjoy this episode
Take care
Bret
This content is not intended to cover all possible diagnosis methods, treatments, follow up, drugs and any contraindications or side effects. In addition since such standards and practices in medicine change as new data become available, you should consult a variety of sources. We strongly recommend that you independently verify specified diagnosis, treatments and follow-up and ensure it is appropriate for your patient within your region. In addition, with respect to prescription medication, you are advised to check the product information sheet accompanying each drug to verify conditions of use and identify any changes in dosage schedule or contraindications, particularly if the drug to be administered is new, infrequently used, or has a narrow therapeutic range. You must always check that drugs referenced are licensed for the specified use and at the specified doses in your region.