More than a skin disease: stress, depression, anxiety levels, and serum neurotrophins in lichen simplex chronicus

Abstract Background: Lichen simplex chronicus is a dermatological condition due to excessive scratching, with few studies on psychoneuroimmunology. Objective: We aimed to estimate the levels of stress, depression, and anxiety, and to measure serum levels of neurotrophins in patients with lichen simplex chronicus, and to correlate these parameters with the severity of the disease and pruritus. Methods: Thirty-six patients with lichen simplex chronicus and 36 age- and sex-matched healthy controls were included. Each participant was administered the Hospital Anxiety and Depression Scale and Perceived Stress Scale questionnaires, along with a visual analog scale for pruritus. Levels of neurotrophins (brain-derived neurotrophic factor, neurotrophin-3, nerve growth factor, glial cell line-derived neurotrophic factor) were determined by ELISA assays. Results: The scores of Perceived Stress Scale-10, Hospital Anxiety and Depression Scale were statistically higher in patients (p < 0.05 for all). The serum levels of all neurotrophins were significantly lower in patients compared to healthy controls (p < 0.05 for all). Disease severity showed no correlation with all four neurotrophins. In linear regression models applied for increased visual analog scale-pruritus scores and disease severity these two variables were statistically significant predictors (p = 0.043). Study limitations: A direct causal relationship was not addressed. Conclusion: Lichen simplex chronicus patients are at risk of increased levels of stress, anxiety, depression, and present decreased levels of neurotrophins, that may suggest a role in the pathophysiology of this disorder.

Focused ultrasound therapy for reducing recurrence of vulvar lichen simplex chronicus in rats: efficacy and mechanism / 南方医科大学学报

OBJECTIVE@#To explore the changes of collagen fibrosis in the vulva skin of SD rats with lichen simplex chronicus (LSC) after focused ultrasound therapy and explore the mechanism by which focused ultrasound reduces the recurrence of vulvar LSC.@*METHODS@#Fifty female SD rat models of vulvar LSC were established and randomly divided into the treatment group and the control group (=25) for treatment with focused ultrasound and sham treatment, respectively. Before and after the treatment, vulvar skin tissues were sampled to observe the pathological changes with HE staining and assess the density of collagen fibers using Masson staining. The ultrastructure of the collagen fibers in the superficial dermis was observed using transmission electron microscopy. The expressions of notch1 and c-fos in the vulvar tissue were detected by immunohistochemistry and Western blotting.@*RESULTS@#After 4 weeks of focused ultrasound therapy, 16% (4/25) of the rats in the treatment group showed lesion progression to LSIL, 4% (1/25) still had LSC, and 80% (20/25) showed normal vulvar skin. In the control group, progression to LSIL occurred in 19 (76%) rats, 3 (12%) rats still showed LSC, and only 3 (12%) had normal vulvar skin. The difference in the cure rate differed significantly between the two groups ( < 0.05). The density of collagen fibers in the superficial dermis and the expressions of notch1 and c-fos in the vulvar skin were significantly lower in the treatment group than in the control group ( < 0.05).@*CONCLUSIONS@#Focused ultrasound therapy can inhibit superficial collagen fibrosis of the dermis by lowering the expressions of notch1 and c-fos in the vulvar skin to reduce the recurrence of vulvar LSC in rats.

Lichen simplex chronicus on the scalp: exuberant clinical, dermoscopic, and histopathological findings

Abstract: Lichen simplex chronicus is a skin disease that mostly affects female patients, with a peak incidence between ages 35 and 50 years. On the scalp, it appears as a single or multiple oval lesions, showing scaling and hair shaft loss or breakage. An important dermoscopic feature of the disease are the "broom fibers." Histopathology reveals the "hamburger" and the "gear wheel" signs. The aim of this report is to demonstrate a case of lichen simplex chronicus on the scalp with typical and exuberant clinical, dermoscopic, and histopathological findings.

One mistake, one life at stake: A case of Methotrexate Toxicity in A 57-Year old male presenting with painful plaques with erosions

Introduction@#Methotrexate is being given by dermatologists in only extreme cases of skin disorders such as in severe Psoriasis Vulgaris. Strict precautionary measures are done to avoid its well-known adverse effects. An early but less common sign of its toxicity are painful erosions on plaques. Methotrexate is an effective but potentially toxic treatment for different severe dermatologic disorders such as in severe Psoriasis Vulgaris. Meticulous and complete history-taking, physical examination and laboratory work-up to come up with a correct diagnosis as well as, knowledge of indications for treatment, proper dosing, folate supplementa-tion, monitoring, proper referral and early detection of its toxicity are important in order to avoid cutaneous and systemic adverse effects including death. @*Case Report@#A case of a 57-year old male with a 2-day history of painful erosions on plaques on both upper and lower extremities after eleven days of taking Methotrexate 2.5mg/tablet one tablet three times a day without folate supplementation. He was then being treated by a general physician as a case of Psoriasis Vulgaris. He was subsequently admitted under the Internal Medicine service due to epigastric pain, nausea, anorexia, generalized body weakness and passage of black tarry stools. He was referred to the Department of Dermatology for the painful erosions on plaques. He expired two days after admission due to Acute Respiratory Failure. Post-mortem Skin punch biopsy was done and revealed chronic eczematous dermatitis consistent with Lichen Simplex Chronicus with superimposed drug induced hypersensitivity reaction.

Psicodermatología en la atención primaria / Psychodermatology in primary care

The skin has the distinction of being the largest, visible and accessible part of the human body, and it hides a close and old relationship with the human psyche, and so has been demonstrated in the last years, where more elements of the Mental Health are elucidated playing a role in the pathogenesis of skin diseases, as well as there are some descriptions of the inverse relationship, this is, on how the skin diseases affect Mental Health of the individual. In this paper we propose to emphasize the importance of the issue, to consider a comprehensive approach to everyday Dermatology in Primary Care Medicine.

Comments to "Localized Darier's Disease Mimicking Lichen Simplex Chronicus on the Back" / 대한피부과학회지

No abstract available.

Localized Darier's Disease Mimicking Lichen Simplex Chronicus on the Back / 대한피부과학회지

Darier's disease is an autosomal dominant acantholytic skin disorder. The disease is characterized by symmetric distribution of hyperkeratotic papules in seborrheic regions of the skin and nail changes with potential for exacerbation by ultraviolet light, heat, occlusion, or stress. It presents as generalized (hypertrophic or vesiculobullous type) or localized (linear or zosteriform type) condition. A 53-year-old male patient presented with hyperkeratotic verrucous papules on the back that had an onset in childhood. Clinically, his condition resembled lichen simplex chronicus. The lesions were exacerbated by sun exposure or sweating. A 3-mm punch biopsy specimen revealed prominent acantholysis with hyperkeratosis and parakeratosis. Numerous corps grains and corps ronds were present near the granular layer. We report a case of localized Darier's disease mimicking lichen simplex chronicus on the back. The skin lesion improved following treatment with a topical corticosteroid. Localized Darier's disease should be considered as one of the differential diagnoses of lichen simplex chronicus on the back.

Autoerythrocyte sensitization syndrome presenting with general neurodermatitis

Autoerythrocyte sensitization syndrome (AES) was first described by Gardner and Diamond in 1955, when four women with painful bruising were depicted. Patients with AES typically present with the development of recurrent, spontaneous, painful ecchymosis, frequently preceded by a prodrome of pain or itching of the skin. The patients are sensitive to their own red blood cells injected intradermally, and underlying coagulopathies are thought to be absent. We introduce a 70-year-old woman presenting with recurrent episodes of painful bruising on the trunk and extremities.

Telemedicine of Skin Diseases in Ulleung Island / 대한피부과학회지

BACKGROUND: Telemedicine can be useful in dermatology on Ulleung island which is 217 km away from Pohang and without dermatologists. OBJECTIVE: The purpose of this study is to measure the effectiveness of telemedicine in treating skin diseases on Ulleung island. METHODS: 33 patients on Ulleung island were examined by a fullmotion real-time video by one dermatologist in a Dongsan hospital of Keimyung University once a week. From June 2011 to June 2012, there have been 53 treatments of telemedicine in 33 patients. RESULTS: 14 diseases were found in 33 patients. The most common disease group was infectious skin disease and eczema in 9 patients. In addition, there were other skin diseases such as acne vulgaris, allergic contact dermatitis, prurigo nodularis, lichen simplex chronicus, malignant melanoma, seborrheic dermatitis, polymorphous light eruption and so on. CONCLUSION: Dermatology favors telemedicine because we had investigated its value and possibilities by clinical experience of telemedicine between Ulleung island and Dongsan medical center in Daegu.

Effectiveness of Topical Chia Seed Oil on Pruritus of End-stage Renal Disease (ESRD) Patients and Healthy Volunteers

BACKGROUND: Several studies have been performed to evaluate the efficacy of dietary n-3 fatty acid for patients with renal dysfunction. While about 40% to 80% of patients with end-stage renal disease (ESRD) complain about pruritus and xerosis, there are few reports on the effects of topical n-3 fatty acid on these symptoms. OBJECTIVE: In order to investigate the possible beneficial effects of topical n-3 fatty acid, oils extracted from chia (Salvia hispanica) seed were formulated into topical products, the effects of which were measured. METHODS: Five healthy volunteers having xerotic pruritus symptoms and 5 patients with pruritus caused by either ESRD or diabetes were involved in this study. A topical formulation containing 4% chia seed oils were applied for an 8-week duration. Subjective itching symptoms were assessed on a 6-point scale, as were other skin functions, namely transepidermal water loss and skin capacitance. RESULTS: After the 8 weeks of application, significant improvements in skin hydration, lichen simplex chronicus, and prurigo nodularis were observed in all patients. A similar improvement was also observed among healthy volunteers with xerotic pruritus. Improvement of epidermal permeability barrier function and skin hydration, represented by trans-epidermal water loss and skin capacitance, respectively, were also observed. No adverse effects were observed in all the tested patients and volunteers. CONCLUSION: Chia seed oil can be used as an adjuvant moisturizing agent for pruritic skin, including that of ESRD patients.

[Lichen amyloidosis and macular amyloidosis patients in a tertiary dermatology centre in Singapore: a 4-year retrospective review]

Lichen amyloidosis[LA] and macular amyloidosis [MA] are uncommon chronic skin conditions which are more frequent in the Asian population. To find associations as well as record the presence/absence of pruritus, we collected retrospectively all cases [1210] of clinically diagnosed LA[948] and MA [262] from 2004 to 2007 attending the National Skin Centre outpatient clinic. The mean age at presentation was 51 years old. 51% of patients had pruritus. Differences between LA and MA were statistically significant [LA to MA odds ratio=OR] regarding sex [males more likely: OR=1.9], race distribution [Chinese: OR=2.1] and in skin diseases, chronic urticaria [OR=2.3] and lichen simplex chronicus [OR=14.3]. Conversely pruritus was more associated with MA: [MA/LA odds ratio=1.3]. In 29 cases contact dermatitis was recorded and in 7 cases, allergic contact dermatitis was confirmed, with positive patch tests to nickel, gold, neomycin and flavin. In 3.22% and respectively 0.33%, LA/MA was associated with chronic idiopathic urticaria and acute urticaria. In this the first study separating LA from MA, we have observed significant differences. Although LA/MA is more frequent in females, odds suggest that male Chinese are more likely to have LA than the other racial groups in Singapore. Also pruritus is more associated with LA than MA. LA/MA is unlikely to have a causal relationship with urticaria. Further studies regarding the timing and intensity of pruritus in relation with the development LA/MA are needed. This should be compared with a control group of patients with eczema only

Prurigo nodular / Prurigo nodularis

Los prurigos constituyen un grupo heterogéneo de trastornos,de etiología dudosa o desconocida, caracterizados por pruritoacentuado, como síntoma subjetivo principal, y una erupción crónica o recurrente de tipo papulonodular, como síntomaobjetivo. Se dividen en agudos y crónicos, y las formas agudasson las más frecuentes en la infancia.Presentamos el caso de un niño con prurigo nodular, la variedadcrónica de los prurigos, de aparición bilateral y simétricaen ambas regiones axilares

Acquired Reactive Perforating Collagenosis in a Chronic HCV Hepatitis Patient Who was Treated with Interferon Alpha / 대한피부과학회지

Reactive Perforating Collagenosis (RPC) is a kind of perforating dermatosis, which shows transepidermal elimination of altered collagens. Acquired form is developed in an adult without family history, is favorably developed in scratched region due to pruritic sense. Acquired RPC has been reported to be associated with various systemic disorders, such as diabetes mellitus, liver disease, chronic renal failure, lymphoma, AIDS, hypothyroidism, hyperparathyroidism, and neurodermatitis, accompanied by itching & scratching. We report a case of acquired RPC in a patient with HCV hepatitis who was treated with interferon alpha. Skin lesions showed multiple erythematous centrally umbilicated, crusted papules of variable sizes on the extensor surfaces of both shins.

A Case of Norwegian Scabies Outbreak / 대한피부과학회지

We present a case of Norwegian scabies in a 79-year-old male with chronic obstructive pulmonary disease, which resulted in a ward outbreak of classical scabies. A total of 23 people including nurses, nursing students, physicians, other patients in the same ward and their families were diagnosed with the infestation. Skin scales from the patient revealed numerous scabies mites (21.3/mg) at various stages from egg to adult. The patient had previously suffered from neurodermatitis and xerotic eczema for 5 years. Long-term systemic steroid therapy was considered as a possible cause of Norwegian scabies in this patient. Control of the infestation was achieved by implementing an immediate surveillance system, strict isolation and administration of scabicidal medication.

Kaposi's Varicelliform Eruption Complicating Lichen Simplex Chronicus

Kaposi's varicelliform eruption results from a widespread infection of a virus to skin damaged by predisposing dermatoses. It is usually a manifestation of a primary herpes simplex virus type 1 (HSV-1) infection in a child with atopic dermatitis, but other skin conditions can be complicated. Here, we report an unusual case of KVE arising from lichen simplex chronicus on the male genital area.

Observation on clinical therapeutic effect of Yang's cotton moxibustion on neurodermatitis / 中国针灸

<p><b>OBJECTIVE</b>To compare the difference of the therapeutic effects between Yang's cotton moxibustion and hormonotherapy on neurodermatitis.</p><p><b>METHODS</b>Sixty cases of neurodermatitis were divided into a treatment group and a control group according to random number table. The treatment group were treated with Yang's cotton moxibustion and the control group with triamcinolone and urea cream. After treatment for one week, the therapeutic effect was start to be observed. After the treatment was given for 4 weeks, the therapeutic effect was evaluated.</p><p><b>RESULTS</b>The total effective rate was 93.3% in the treatment group and 80.0% in the control group, with a significant difference between the two groups (P < 0.05).</p><p><b>CONCLUSION</b>Yang's cotton moxibustion has an obvious therapeutic effect on neurodermatitis with a good safety.</p>

Observation on the therapeutic effect of a red-hot needle therapy combined with blood-letting puncture and cupping for treatment of neurodermatitis / 中国针灸

<p><b>OBJECTIVE</b>To search for an effective therapy for neurodermatitis.</p><p><b>METHODS</b>Ninety-six cases were divided into 2 groups by random number table. The treatment group (n = 54) were treated by hot-red needle therapy combined with blood-letting puncturing and cupping at skin-injured area, and the control group (n = 42) were treated with external smearing of halometasone cream.</p><p><b>RESULTS</b>The cured rate and the total effective rate were 51.9% and 96.3% in the treatment group, and 28.6% and 81.0% in the control group, respectively, with a significant difference between the two groups in the therapeutic effect (P < 0.05).</p><p><b>CONCLUSION</b>Red-hot needle therapy combined with blood-letting puncture and cupping has a definite therapeutic effect on neurodermatitis, without toxic and adverse effects.</p>

Liquen simple crónico vulvar unilateral / Lichen simplex chronicus

Presentamos un caso de liquen simple crónico vulvar izquierdo, en una paciente con diagnóstico psiquiátrico de trastorno bipolar, tratado repetidamente como micosis. Se realizó biopsia que confirmó el diagnóstico y se trató exitosamente con antihistamínicos orales y corticoides tópicos.

A Clinicopathological Study of Palmoplantar Dermatoses / 대한피부과학회지

BACKGROUND: Palmoplantar dermatoses have frequently been encountered in the dermatologic field. Many previous studies have focused on the specific diseases of palmoplantar dermatoses; however, none of them have included a the comprehensive study of palmoplantar dermatoses. OBJECTIVE: The purpose of this study was to investigate the epidemiological aspects of palmoplantar dermatoses, with a brief review of the common palmoplantar dermatoses. METHODS: We retrospectively reviewed the data of 237 patients who had been biopsied for palmoplantar dermatoses between January 2000 and December 2004 at Our Lady of Mercy Hospital, The Catholic University of Korea. RESULTS: The results were as follows; Female to male ratio was 1 : 1.01. The mean age at diagnosis was 37.5+/-20.1 years. The mean duration of the disease was 35.9 months and ranged from 2 days to 50 years. Palmoplantar dermatoses appeared on the palms in 49 (20.6%) patients, the soles in 123 (51.9%) patients, and both the palms and soles in 65 (27.4%) patients. The most common five diseases of palmoplantar dermatoses were palmoplantar pustulosis (23.2%), verruca (11.4%), pompholyx (10.1%), palmoplantar keratoderma (8.9%), and contact dermatitis (8.0%). Of the 237 patients, 65 (27.4%) patients were accompanied with other dermatoses; fungal infection (13.9%), eczema (7.6%), onychodystrophy (3.4%), psoriasis (1.7%), erythema multiforme (1.3%), hyperhidrosis (1.3%), drug eruption (0.8%), or lichen simplex chronicus (0.4%). Of the 237 patients, 51 (21.5%) patients were accompanied with systemic diseases; Cardiovascular diseases (8.4%), endocrine diseases (6.6%), hepatobiliary diseases (4.6%), malignancy (3.4%), pulmonary diseases (2.5%), or gastrointestinal diseases (1.3%). CONCLUSION: Our study shows that the biopsy of palmoplantar dermatoses is gradually increasing. Further investigation with a wider and larger population is necessary to understand the epidermiology of palmoplantar dermatoses, and, based on the epidermiology of palmoplantar dermatoses, accurate diagnosis and proper treatment of palmoplantar dermatoses could then be achieved.