British Journal of Dermatology (1973) 89, 625.

Atopy in lichen simplex (neurodermatitis

drcumscripta)
GURMOHAN SINGH
Head, Section of Skin and Venereal Disease, Institute of Medical Sciences, Banaras Hindu University, India
Accepted for publication 7 May 1973

SUMMARY

A Statistical study of 102 patients with lichen simplex lesions and a large group of controls shows a
significant association between this disease and a personal and family history of atopic disorders.
This communication compares the prevalence of a personal and family history of atopy in patients
with lichen simplex with that in a control group.
MATERIAL AND METHOD

Patients were unselected. A detailed inquiry was made to elicit any history of atopy in the patient or
his relatives.
A clinical diagnosis of lichen simplex was made when the patient had lesions on the nape of the
neck, ulnar border of the forearm, pretibial area and other sites which are easily accessible to rubbing
and scratching. In the present study group the following sites were involved (Table i).
TABLE I.

No. of patients Percentage

Site involved
Neck only
Ulnar border of one forearm
Ulnar border of both forearms
Pretibial skin
Pretibial skin, forearm and neck
Neck and forearm
Neck and leg
Neck and arm
Arm and leg
Total

49
15
II

481
147
108

8
6
3
3

2-9
29

2-0

5
102

78
59

49
1000

A random sample of iooo control subjects from the Skin and Venereal Disease Outpatients Department and the General Medical wards of the hospitals, who had attended for any disease other than
psychogenic or allergic, were similarly interviewed (Singh, 1972).
F

625

626

Gurmohan Singh
RESULTS

Table 2 shows the incidence of personal allergic manifestations in patients and controls.
TABLE 2. Showing incidence of different allergic manifestations in cases of
lichen simplex and controls.
Allergic
manifestations

Asthma '
Allergic rhinitis
Urticaria, recurrent
Urticaria, evanescent
Non-allergic
Concomitant (two or more)
allergic manifestations

Lichen
simplex
(i02 patients)

No.

i6
27
7
13

157
265
6-9
127

52

509

13

127

Controls
Z

64

25206

154 15-4

24523
0 9126
i-8io8

<0 02
<0 02
>O36

(1000

patients)
No. %
64

45 45
66 66
738 738
67

4-58

>0

01

<0

0I

67

Statistical analysis
(1) The incidence of asthma and allergic rhinitis in patients with lichen simplex is significantly higher
than in controls.
(2) There is no significant difference in the incidence of a personal history of urticaria (either recurrent or evanescent) in the two groups.
(3) The percentage of subjects lacking a personal history of allergy is higher in the controls as
compared to patients with lichen simplex. The difference is highly significant.
A family history of atopy was present in forty-five subjects (44-1%). Table 3 shows the family
history of atopy in patients with lichen simplex and in controls.
TABLE 3.

Group

No. of subjects No. with positive Percentage

family history
studied

(a) Lichen simplex

(b) Control group as a whole
(c) Controls with history of one
or more allergic manifestations

102

45

1000

170

441
17-0

313

109

348

Statistical analysis
(1) When (a) and (b) are compared by applying the Chi square test, the value of x^ is 41-63. Table
values of P for one degree of freedom are <o-ooi; The difference is therefore highly significant.
(2) On comparing (a) and (c), the Chi square is 2-4626 and the table values of P for one degree of
freedom are < o i o . The difference is not significant.
DISCUSSION

The lesions seen in lichen simplex are similar to those seen in atopic dermatitis (also called Besnier's
prurigo and neurodermatitis disseminata). There is, however, a difference in severity and sites of

Atopy in lichen simplex

627

involvement. In atopic dermatitis the lesions are usually bilateral and involve the ante-cubital and
popliteal fossae, the neck and other flexural areas. Patients with atopic dermatitis have a high incidence of other atopic manifestations, such as asthma and allergic rhinitis, and there is frequently a
very strong family history of atopy.
Morphological similarities between the individual lesions of atopic dermatitis and of lichen simplex
suggest that these two entities may in some way be related to each other.
The data analysed indicate that a larger percentage of subjects with lichen simplex had atopic
manifestations as compared to controls who were not suffering from atopic disorders. The differences
were statistically significant.
The history of atopy in members of the family, which included parents, siblings and children,
was positive in 44-1% of patients as compared to 17-0% in controls. These differences were statistically highly significant. The association with atopy is further supported by comparing the incidence
of atopy in families of patients with lichen simplex with that of the group of control subjects
who had given a positive personal history of one or more atopic manifestations; they were not
significantly different.
These results differ from those of Carr, Berke & Becker (1964), who made the only other investigation on this subject of which we are aware. They studied fifty-three subjects with lichen simplex and
found no significant increase in the atopic background as compared to a control population. Unfortunately, they gave no criteria for the diagnosis of lichen simplex. A diagnosis of lichen simplex
is made by some dermatologists only when the patient gives no history of atopy. If a clear history
of atopy (personal or familial) is elicited, the diagnosis is recorded as atopic dermatitis. Sulzberger et
a/. (1961) also have stated that the absence of other findings of atopy helps to distinguish cases of
lichen simplex from atopic dermatitis. If the lack of history of atopy is taken as a criterion for the
diagnosis of lichen simplex, it is evident that the cases to which he applies this diagnosis are those
without an atopic background. This deliberate though unconscious selection of patients may explain
the findings of Carr et al. (1964).
ACKNOWLEDGMENTS

I am thankful to Dr K.N.Udupa, M.S., F.R.C.S., Director, Institute of Medical Sciences,

Banaras Hindu University, for providing facilities and permission to publish this report. My thanks
are also due to Mr N.S.Murthy, Lecturer in Statistics, for helping in statistical analysis.
REFERENCES
CARR, R.D., BERKE, M . & BECKER, S.W. (1964) Incidence of atopy in patients with various neurodermatoses.
Archives of Dermatology, 89, 20.
SINGH, G . (1972) Prevalence of atopy. Paper presented at Vlth Annual Convention of Indian College of Allergy
and Applied Immunology held at Varanasi in October-November, 1972.
Stn.ZBERGER, W.B., WOLF, J., WITTEN, V . H . & KOPF, A.W. (1961) Dermatology: Essentials of Diagnosis and
Treatment. Year Book Publishers, Chicago.