Lichen Simplex Chronicus Itch: An Update.

Lichen simplex chronicus is a form of chronic localized pruritus with a secondary dermatitis, and one of the most common types of chronic itch conditions, estimated to affect more than 10% of the general population. However, despite its prevalence and burden, there has been limited research into the pathogenesis and aetiology of lichen simplex chronicus, which, historically, made it a challenging condition to treat. In recent years, our understanding of this condition, along with that of pruritus and the itch-scratch cycle, has increased greatly, enabling a substantial increase in treatment options. In addition, there are several new promising treatments currently in development and trials. This article discusses the definition, epidemiology, clinical characteristics, pathophysiology, and current therapeutic options for lichen simplex chronicus, in order to highlight recent advancements in this field.

Scalp dysaesthesia and lichen simplex chronicus: diagnostic and therapeutic update with literature review.

Scalp dysaesthesia, considered a variant of the cutaneous dysaesthesia syndrome, is characterized by chronic sensory symptoms, including pruritus, pain, burning and stinging in a well-defined location, without objective findings. Its aetiology is not well elucidated and treatment options are limited, thus it can be challenging and frustrating for both patient and physician. It can be associated with lichen simplex chronicus. In this paper, we review the literature on the pathogenetic factors, diagnostic methods and therapeutic options in the management of scalp dysaesthesia. Dissociation, cervical spine disease and muscle tension seem to be the most important pathogenetic factors. Trichoscopy, reflectance confocal microscopy and biopsy are all helpful for the diagnosis of the disease. Therapies include high-potency topical or intralesional corticosteroids, capsaicin and topical anaesthetics, sedative antihistamines, tricyclic antidepressants, transcutaneous electric nerve stimulation, botulinum toxin and vitamin B12.

Comparison of efficacy and safety of high-intensity focused ultrasound at different powers for patients with vulvar lichen simplex chronicus.

OBJECTIVE: To compare the efficacy and safety of the treatment of vulvar lichen simplex chronicus (VLSC) using high-intensity focused ultrasound (HIFU) at different powers. METHODS: This retrospective study included 152 patients with VLSC. Among these patients, 70 were treated with HIFU at low power (level 2), and 82 were treated at normal power (level 3). The treatment responses, recurrence rates and intra- and postoperative complications were all compared. RESULTS: No statistically significant differences were found between the two groups in age, disease course, menopause status, lesion size and severity of symptoms. All patients received one session of HIFU therapy, and the treatment process was successful. No difference was found in the total response rate between the two groups at 1 (85.7% versus 87.8%, p = .35), 6 (80% versus 80.5%, p = .65) and 12 (80% versus 80.5%, p = .73) months after HIFU therapy. No significant difference was observed in the recurrence rate between the two groups at 6 (5.7% versus 9.8%, p = .36) and 12 (22.9% versus 26.8%, p = .57) months after HIFU treatment. Patients in the low-power group had a lower incidence of blisters (10% versus 23.3%, p = .04). CONCLUSION: Based on our results, low-power HIFU treatment can achieve a therapeutic effect similar to normal power HFU treatment for VLSC, but its incidence of side effects is lower.

Patterns of Skin Disease in the Context of a High Prevalence HIV Population in Botswana.

The authors reviewed outpatients in a tertiary dermatology clinic in Botswana to expand knowledge on patterns of skin disease in this population with a high prevalence of human immunodeficiency virus (HIV). Approximately one-third of new and follow-up patients were HIV positive. Common dermatologic conditions included eczematous eruptions, viral and fungal infections, malignant neoplasms, vascular disorders, disorders of pigmentation, and mechanical/physical injury-related disorders. HIV has impacted patterns of dermatologic disease in Botswana, with Kaposi sarcoma being the most frequently biopsied condition. Given the shortage of dermatology specialists, resources should be allocated toward education and management of these most prevalent skin conditions.

Cupping for neurodermatitis: A protocol of systematic review and meta-analysis.

BACKGROUND: Neurodermatitis is a common inflammatory and allergic disease, characterized by itching and lichenification plaque. Some studies have reported cupping therapy (CT) for the treatment of neurodermatitis. However, the effectiveness and safety are still uncertain. This study aims to evaluate the efficacy and safety of CT for the treatment of patients with neurodermatitis. METHODS: We will retrieve the following electronic databases systematically: Pubmed, Web of Science, Embase, the Cochrane Library, Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, Chinese Biomedical Literature Database, and Wanfang database from their inception to December 2020. Other literature resources will be manually searched. Published randomized controlled trials (RCTs) and quasi-randomized controlled trials (q-RCTs) on the topic will be retrieved by 2 investigators independently. We will apply a fixed-effect model or random effect model basis on the heterogeneity test and employ with RevMan 5.3 software for data synthesis. The total clinical effective rate will be selected as the primary outcome, skin disease quality of life index score, recurrence rate, and adverse events as secondary outcomes. RESULTS: This study will comprehensively summarize the high-quality trials to determine the efficacy and safety of CT for the treatment of patients with neurodermatitis. CONCLUSION: Our systematic review will present evidence for the efficacy and safety of CT to neurodermatitis patients. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/6DCM3.

Common Benign Chronic Vulvar Disorders.

Common benign chronic vulvar conditions include genitourinary syndrome of menopause (formerly called vulvovaginal atrophy), lichen sclerosus, lichen planus, lichen simplex chronicus, and vulvodynia. Genitourinary syndrome of menopause results from the hypoestrogenic state that leads to atrophy of normal vulvar and vaginal tissues. It is typically treated with lubricants, moisturizers, and intravaginal estrogen. Lichen sclerosus is an inflammatory condition characterized by intense vulvar itching. It is treated with topical steroids or, in some cases, topical calcineurin inhibitors. Patients with lichen sclerosus are at risk of vulvar squamous cell carcinoma and should be monitored closely for malignancy. Lichen planus is an inflammatory autoimmune disorder that can affect the vulva and vagina in addition to other skin and mucosal surfaces. The first-line treatment is topical steroids, and significant scarring can occur if left untreated. Lichen simplex chronicus manifests as persistent itching and scratching of the vulvar skin that leads to thickened epithelium. Breaking the itch-scratch cycle, often with topical steroids, is the key to treatment. Vulvodynia is a common vulvar pain disorder and is a diagnosis of exclusion. A multimodal treatment approach typically includes vulvar hygiene, physical therapy, psychosocial interventions, and antineuropathy medications.

Therapeutic Effects of Focused Ultrasound on Expression of Notch1, C-Fos and Transforming Growth Factor-ß3 in Vulvar Skin of SD Rats with Vulvar Lichen Simplex Chronicus.

The purpose of this study was to investigate the therapeutic effects of focused ultrasound on the expression of notch1, c-fos and transforming growth factor-ß3 (TGF-ß3) in genital skin of SD rats with vulvar lichen simplex chronicus (LSC). Fifty-six female SD rats with LSC were randomly divided into therapy and sham groups. The therapy group was exposed to focused ultrasound. The sham group received the same therapy with an instrument that had no power output. Four wk after a singly focused ultrasound therapy, histologic analyses revealed that recovered SD rats accounted for 75% of SD rats in the therapy group and 10.7% in the sham group. Total collagen fiber density in the superficial layer of dermis in the therapy group was significantly lower than that in the sham group. Notch1 and c-fos protein expression in the therapy group was significantly lower than that in the sham group, with the opposite effect present for TGF-ß3. Focused ultrasound therapy may inhibit superficial collagen fibrosis in the dermis by affecting expression of notch1, c-fos and TGF-ß3 in vulvar skin tissue and consequently reduce the recurrence rate of LSC.

[Patient education for adults with atopic dermatitis according to the ARNE concept]. / Neurodermitis-Erwachsenenschulung nach dem Konzept der "Arbeitsgemeinschaft Neurodermitisschulung für Erwachsene" (ARNE).

Atopic dermatitis (AD) represents a chronic inflammatory skin disease showing a 1-year prevalence of 2-3% during adulthood. In a national randomized, controlled multicenter study initiated by the "Arbeitsgemeinschaft Neurodermitisschulung im Erwachsenenalter" (ARNE, Working Group on Educational Training for Adults with Atopic Dermatitis) a program for structured patient education conducted by a multiprofessional team was developed and evaluated. At 1­year follow-up, coping behavior with respect to itch (assessed by the "Juckreiz-Kognitions-Fragebogen", p < 0.001) and in quality of life (Skindex-29, p < 0.001) significantly improved in patients who had participated in this 12 h patient educational program (n = 168) compared to the waiting control group (n = 147). Moreover, the training led to a significantly greater reduction in disease severity (SCORAD Index, p < 0.001). In this first randomized, controlled multicenter study on effects of patient education in adulthood AD, significant beneficial effects on both psychosocial parameters and the disease severity could be demonstrated.

Vulvar Pruritus and Lichen Simplex Chronicus.

Vulvar pruritus and lichen simplex chronicus are common reasons for presentation to women's health practitioners, including gynecologists and dermatologists. Both conditions are multifactorial and are often confounded by other inflammatory, neoplastic, infectious, environmental, neuropathic, hormonal, and behavioral variables. Careful history taking and thorough physical examinations, including wet mount and potentially skin biopsy, are necessary for appropriate diagnosis. Treatment should focus on decreasing inflammation, reducing irritants, and providing symptomatic relief to achieve remission. Comprehensive treatment covering environmental, biological, and behavioral therapy can result in long-term cure for patients with these conditions.

Differences Between Men and Women in Chronic Scratching: A Psychodermatologic Study in Lichen Simplex Chronicus.

INTRODUCTION: Chronic scratching is common to many skin disorders. Being a female and presenting a high level of psychopathology are risk factors for chronic scratching. Yet, it is unclear why. Certain personality characteristics that are more prevalent in women are also known to influence emotional states (i.e. emotional tension). OBJECTIVE: The present study aims to explore whether these personality styles might help understand why gender and emotional distress are associated with scratching. MATERIAL AND METHODS: We compared the personality patterns of 103 patients (69.9% women) diagnosed with Lichen Simplex Chronicus, against a sample of healthy individuals. RESULTS: Significant differences were found in the personality styles of men and women with LSC. Women were more pessimistic, oriented to fulfil the needs of others, traditional, insecure, submissive, and reserved, with moderate (d=.43) to strong (d=.96) size effects ranges. Some of these differences, such as in traditionalism, dutifulness, other-orientation, and pessimism, were also observed when compared with healthy men and women, with small (d=.03) to moderate (d=.47) size effects ranges. CONCLUSIONS: These psychological factors may help explain the mechanisms underlying gender differences in chronic scratching, at least in Lichen Simplex Chronicus. The findings might open new avenues for research and treatment.

Inflammatory Vulvar Dermatoses.

Inflammatory vulvar dermatoses affect many women, but are likely underdiagnosed due to embarrassment and reluctance to visit a health care provider. Although itch and pain are common presenting symptoms, the physical examination can help distinguish between different disease entities. Because many women's health providers have minimal training in the categorization and management of dermatologic disease, definitive diagnosis and management can be difficult. Herein, strategies for diagnosing vulvar lichen sclerosus, lichen planus, contact dermatitis, lichen simplex chronicus, and psoriasis are discussed along with basic management of these diseases, which commonly involves decreasing inflammation through behavioral change, gentle skin care, topical corticosteroids, and systemic therapies.

[Vulvar pruritus: determination of the most common causes and their treatments]. / Prurito vulvar: determinación de las causas más frecuentes y su tratamiento.

Vulvar pruritus can be caused by a wide spectrum of diseases, that depend on age, environmental and genetic factors. The most common causes are candidiasis, contact dermatitis and lichen simplex chronicus. Candidiasis is the most common cause of acute vulvar pruritus and is characterized by burning, itching and vaginal whitish secretion. Contact dermatitis is caused by irritants or allergens that are in contact with the genital area, which causes imbalance in the skin barrier causing irritation, swelling, burning, among other manifestations. Lichen simplex chronicus is characterized by lichenification (thickening of the skin) secondary to the chronic itch-scratch cycle in vulvar area. It is an illnes with a tendency to chronicity, but with topical corticosteroids treatment usually might be controlled. Prompt treatment, multidisciplinary and careful attention to irritants and secondary infections prevent these entities become an important and permanent problem.

Effectiveness of silk fabric underwear as an adjuvant tool in the management of vulvar lichen simplex chronicus: results of a double-blind randomized controlled trial.

OBJECTIVE: Avoiding potentially irritating contact is a key point in vulvar lichen simplex chronicus (VLSC) management. This study aims to assess the use of nonirritating silk fabric underwear (Dermasilk) as an adjuvant tool in the treatment of VLSC. METHODS: Twenty women with VLSC were enrolled in a 1-week open-label active treatment phase with topical 0.1% mometasone furoate (MMF) ointment. Participants then entered a 4-week double-blind maintenance phase (MP) in which they were randomized to wear either silk fabric or cotton briefs. During MP, participants were allowed to use MMF on an "as-needed" basis. The main efficacy endpoints were to assess and compare the two intervention groups on the following: (1) number of participants who needed to apply MMF throughout MP; (2) mean number of MMF applications; (3) mean symptom-free interval before MMF reapplication; and (4) changes in the severity of symptoms and signs. RESULTS: During MP, four women in the silk fabric briefs group applied MMF compared with six women in the cotton briefs group (relative risk, 0.66). The mean number of MMF applications was lower in the silk fabric briefs group than in the cotton briefs group (P = 0.074). VLSC symptom-free interval was 22.5 days in the silk fabric briefs group and 7.2 days in the cotton briefs group (P = 0.0003). At the end of MP, symptom improvement determined after corticosteroid use increased in the silk fabric briefs group but worsened in the cotton briefs group. CONCLUSIONS: Silk fabric underwear may be a useful tool for the management of VLSC by diminishing external sources of irritation and may reduce use of corticosteroids.

Similarities between neuropathic pruritus sites and lichen simplex chronicus sites.

BACKGROUND: Localized itch of non-pruritoceptive origin is often neuropathic and may be referred to as neuropathic itch syndrome. OBJECTIVES: To describe the results of nerve conduction studies in patients with anogenital pruritus, brachioradial pruritus and scalp dysesthesia, and compare these sites to typical sites of lichen simplex chronicus (LSC). METHODS: The study summarizes previously published data combined with unpublished data of patients with scalp dysesthesia. Nerve conduction studies included measurements of distal sensory and motor latency, conduction velocity and F-responses. RESULTS: A neuropathy was demonstrated in 29 of 36 patients with anogenital pruritus (80.5%), 8/14 with brachioradial pruritus (57.1%) and 4/9 with scalp dysesthesia (44.4%). The typical sites overlapped with some but not all LSC sites. CONCLUSIONS: A considerable proportion of patients with brachioradial pruritus, anogenital pruritus and scalp dysesthesia have abnormal nerve conduction findings, suggesting a neuropathic origin. The skin sites overlap with some common LSC sites, suggesting that in some cases of LSC a local neuropathy could be a possible cause.

Chemical burn caused by topical application of garlic under occlusion.

Allium sativum (garlic) can cause an irritant contact dermatitis, secondary to naturopathic practices. We report an unusually severe case of chemical burn following garlic applied under occlusion.

[Requirements for quality indicators. The relevance of current developments in outcomes research for quality management]. / Anforderungsprofil an Qualitätsindikatoren. Relevanz aktueller Entwicklungen der Outcomes Forschung für das Qualitätsmanagement.

The assessment of the health state in patients and changes in their health state for the purpose of diagnosis, prognosis and monitoring of treatment response plays a central role in clinical practice. Quality criteria for measurements in medicine include validity, reliability, responsiveness, interpretability, and feasibility. High-quality measurement instruments are a prerequisite for evidence-based medicine. Therefore, international outcomes research groups have developed methods for quality assurance and for the standardisation of measurement instruments. Quality indicators are instruments to measure the quality of care. Due to the increasing relevance of quality assessment for all stakeholders in healthcare and due to the political intention to draw relevant conclusions from the assessment of the quality of care, quality indicators must at least meet the same high standards that are required for clinical trial end points. However, independent researchers and clinicians do not engage in the validation and standardisation of quality indicators in Germany; currently, only the AQUA institute (as assigned by the German GBA) deals with this important issue. Current activities concerning the validation of quality indicators do not meet the requirements of evidence-based healthcare. This is a critical barrier to achieving the political goals of quality medicine. Therefore, the authors propose a multi-step, multi-professional, evidence-driven and evidence-generating consensus process on the basis of established methods of outcomes research for the advancement of quality assessment with quality indicators in Germany. All relevant stakeholders should participate in this process.

Recognition and management of vulvar dermatologic conditions: lichen sclerosus, lichen planus, and lichen simplex chronicus.

Lichen sclerosus, lichen planus, and lichen simplex chronicus are dermatologic conditions that can affect the vulva. Symptoms include vulvar itching, irritation, burning, and pain, which may be chronic or recurrent and can lead to significant physical discomfort and emotional distress that can affect mood and sexual relationships. With symptoms similar to common vaginal infections, women often seek care from gynecological providers and may be treated for vaginal infections without relief. Recognition and treatment of these vulvar conditions is important for symptom relief, sexual function, prevention of progressive vulvar scarring, and to provide surveillance for associated vulvar cancer. This article reviews these conditions including signs and symptoms, the process of evaluation, treatment, and follow-up, with attention to education and guidelines for vulvar care and hygiene.