Lichen Simplex Chronicus (LSC)

00:01 Our topic now brings us to lichen simplex chronicus.

00:05 Allow the name to speak to you.

00:07 I’ve mentioned a few times the term lichen or lichenification.

00:12 The last time I talked about this is -- remember that patient who may have an eczema or eczematous type of a lesion, let’s say a child around the, let’s say cheek or face or whatever it may be, maybe around the extensors.

00:25 Itch, itch, itch, Itch, itch, itch, huh? And at some point when there’s enough itching, what’s going to happen? You’ll have dryness that’s taking place, and we call that lichenification.

00:35 You have lichen, and then chronicus, what does that mean? Chronic.

00:39 So, over a long period of time, you have a patient, take a look at my etiology, neurodermatitis, what does that mean? Meaning to say that I feel like I need to itch, so it’s this self-itch type of perpetuating cycle.

00:53 So, what do you want to do? You might want to educate your patient to stop the itch psychologically.

00:59 To be conservative in terms of management.

01:02 It’s perpetuated by this itch-scratch cycle as I mentioned.

01:06 Lichen means excessive pruritic type of itchiness, which then results in dryness called lichenification, over a long period of time, chronicus.

01:20 Morphology: Plaques of thickened skin due to all this itching.

01:24 If you take a look at the picture here, you’ll notice that it is hardened, a plaque and it looks dry.

01:31 Due to constant manipulation, in other words, the itching, and only occurs in those areas that are reachable, and that’s important.

01:37 So therefore, if you’re reaching for that flexor/extensor area and you itch, itch, itch, you may result in this particular condition.

01:45 Management: potent topical steroids, and then you need to be able to educate your patient because even with that though, if you have not interrupted the itch-scratch cycle, then for the most part, management becomes quite difficult The differentials.

01:58 Quickly here, contact dermatitis.

02:01 Let’s say that you got exposed to poison ivy, that I’ve showed you picture for.

02:05 Usually revealed by history.

02:07 Contact dermatitis may complicate or perpetuate lichen simplex chronicus, and that’s a good point.

02:13 In fact, remember, anything that causes initial pruritic changes, any type of dermatitis, if you’re able to scratch enough, then it’s going to perpetuate into lichen simplex chronicus.

02:27 Is that clear? What about psoriasis? Remember, it may result in a plaque-like formation in this condition.

02:33 In psoriasis, it is going to be salmon-colored silver.

02:37 The genetics will give you more of an issue with psoriasis, you’ll see.

02:41 Now, with psoriasis, the histopathology is going to become important.

02:46 And here, I’ll mention it now, and I’ll keep repeating it, demonstrates neutrophilic microabscesses within and, and with the epidermis, it is the loss of the granular layer.

02:59 In other words, you’ve heard of the corneum, granulosum, so on and so forth.

03:04 Here, you’ll be paying attention to that granular layer, which is absent in psoriasis.

03:10 Histopathology becomes important.

03:12 And tinea, well, what do you know about tinea? Well, it’s a fungal infection superficially.

03:17 And think about all of the common reasons as to why you could have fungal infection underneath the nail, unguium.

03:23 In the groin area, we will call that cruris or jock itch.

03:26 Athlete’s foot, you’ve heard it before, that’s tinea pedis.

03:29 So, that type of history is going to tell you that the patient is suffering from a fungal infection.