Our topic now brings us to
lichen simplex chronicus.
Allow the name to speak to you.
I’ve mentioned a few times the
term lichen or lichenification.
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.
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.
You have lichen, and then
chronicus, what does that mean?
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.
So, what do you want to do?
You might want to educate your patient
to stop the itch psychologically.
To be conservative in
terms of management.
It’s perpetuated by this
itch-scratch cycle as I mentioned.
Lichen means excessive
pruritic type of itchiness,
which then results in dryness
over a long period
of time, chronicus.
Plaques of thickened skin
due to all this itching.
If you take a look
at the picture here,
you’ll notice that it is hardened,
a plaque and it looks dry.
Due to constant manipulation,
in other words, the itching,
and only occurs in those areas that
are reachable, and that’s important.
So therefore, if you’re reaching
for that flexor/extensor area
and you itch, itch, itch, you may
result in this particular condition.
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
and the patient is now stuck on
drugs to be taken for a long time
when really, psychologically, they could,
they could exercise self-restraint.
Quickly here, contact dermatitis.
Let’s say that you got exposed to poison
ivy, that I’ve showed you picture for.
Usually revealed by history.
Contact dermatitis may complicate or
perpetuate lichen simplex chronicus,
and that’s a good point.
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
Is that clear?
What about psoriasis?
Remember, it may result in a plaque-like
formation in this condition.
In psoriasis, it is going to
be salmon-colored silver.
The genetics will give you more of
an issue with psoriasis, you’ll see.
with psoriasis, the histopathology
is going to become important.
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.
In other words, you’ve heard of the
corneum, granulosum, so on and so forth.
Here, you’ll be paying attention
to that granular layer,
which is absent in psoriasis.
And tinea, well, what do
you know about tinea?
Well, it’s a fungal
And think about all of the
common reasons as to why
you could have fungal infection
underneath the nail, unguium.
In the groin area, we will
call that cruris or jock itch.
Athlete’s foot, you’ve heard
it before, that’s tinea pedis.
So, that type of history
is going to tell you
that the patient is suffering
from a fungal infection.