NEURODERMATITIS

(LICHEN SIMPLEX CHRONIC)

By :
Yusran Ady Fitrah
Filianmi Dyospama Patandianan
Setiawan Winarso
Advisor :
dr.Regina Mihardja
Supervisor :
Dr. dr. Khairuddin Djawad, SpKK(K)
DERMATOVENEROLOGY DEPARTMENT
FACULTY OF MEDICINE
HASANUDDIN UNIVERSITY

Definition
A chronic, severely pruritic disorder

characterized by one or more lichenified

plaques.
Most common sites of involvement are scalp,
nape of neck, extensor aspects of extremities,
ankles, and anogenital area.

Epidemiology
Lichen simplex chronicus affects adults,

predominantly from ages 30 to 50.

Females are affected more commonly than
males.

Etiology
Pruritus can be caused by the by various

factors which are not understood well.

There is association between neurodermatitis
and atopic disorders.
Enviromental factors: heat, sweat, and
irritation
Emotional and psychological factors

Pathomechanism
Lichen simplex chronicus is induced by

rubbing and scratching secondary to itch.

Various factors incite itch in both disorders
and not all are well understood.

Clinical manifestation
Itching
First lession can be eritomatous plaque
Later became edema, erythema disappeared,

scaly and thickened, lichenification and

excoriation
Around the lesion can be hyperpigmentation
Follicular papules may arise especially at
forearm and elbow

Clinical manifestation
The most common sites of involvement are

the scalp, the nape of the neck (especially in

women), the ankles, the extensor aspects of
the extremities, and the anogenital region.

Lichen simplex chronis at abdomen regio (a); lichenfication

area because of scracthing at upper thigh regio (b); Lichen
simplex chronic at vulva (c).

Lichen simplex chronic at scalp (a), medial part of ankle

joint (b). folikular papule at elbow (c).

Histopatology
Hiperplasia epidermal,

hiperkeratosis with paraand ortokeratosis, akantosis

,dan hipergranulosis with
elongation regular rete
ridges.
Dermis papiler show
thickening colagen with
rough colagen shaft and
vertikal line. There is
perivaskular infiltration of
lymphocytes and
sometimes macrofag
(A)- Histopatology of Lichen skelrosus. (B)-Histopatology of lichen simplex
chronic.

Differential Diagnosis
Lichen simplex: erythemateous polygonal

papules with white lines (Wickham striea) and

scales atop it. Locations usually bilaterally and
symmetrically over extremities

Lichen

Neurodermatit

Differential Diagnosis
Psoriasis: Red, scaly, symmetrically

distributed plaques. Usually found at extensor

aspects of the extremities, scalp, lower
lumbosacral, buttocks, and genital.

Psoriasis

Neurodermatit

Differential Diagnosis
Mycosis fungoides: Early lesion is

erythematous, scaly macules which may

develop into plaques. Usually found at the non
sun-exposed sites.

Mycosis
fungoides

Neurodermatit

Differential Diagnosis
Atopic dermatitis: In chronic, it can be

lichenified due to scratching. It is usually

found at face and extensor aspect (infant),
elbow and knee flexures, sides of neck, wrist,
ankle (childhood and adult)

Atopic

Neurodermatit

Differential Diagnosis
Disease Efflorecenc
s
es

Location

Itch
sensation

Neurode
rmatitis

Lichenified,
scaly
plaques. May
develop to
hyper/hypopi
gmentation

Scalp, nape
of neck,
extensor
aspects of
extremities,
anogenital

Severe

Lichen
planus

Erythematou
s papules
with
Wickham
striae and
scales

Extremities
(flexural
areas),
thighs, lower
back, trunk,
and neck

Not always,
may be not
exist

Psoriasis

Erythematou
s plaques
with scaling

Extremities
(extensor
areas), scalp,
lower
lumbosacral,
buttocks, and

Varies among
patients;
usually found
at
erythrodermic
form; may

Other
symptoms

Nail
changes,
such as nail
pitting, and
arthritis
may be

Differential Diagnosis
Disease Efflorecenc
s
es

Location

Itch
sensation

Neurode
rmatitis

Lichenified,
scaly
plaques. May
develop to
hyper/hypopi
gmentation

Scalp, nape of
neck, extensor
aspects of
extremities,
anogenital

Severe

Mycosis Erythematou
fungoide s, scaly
s
macules.
Plaques may
arise.

Non sunexposed sites.

Often
intense

Fever, chills,
weight loss,
malaise,
insomnia
due to
pruritus

Atopic
dermatit
is

Face and
extensor aspect
(infant)
Elbow and knee
flexures, sides
of neck, wrist,

Intense,
may get
worse in
early
evening
and night

Dry skin,
allergic
rhinitis and
asthma may
be found

Erythematou
s papules,
vesicles. Can
develop to
lichenificatio
n in chronic

Other
symptoms

Treatment
Treatment is aimed at interrupting the itch

scratch cycle.
first-line measures to control itch include
potent topical steroids as well as nonsteroidal
antipruritic preparations such as menthol,
phenol, or pramoxine
Intralesional steroid beneficial for thickend
plaque
Anti-histamint for abolish nighttime itch and
SSRIs for abolish daytime itch in patient OCD

Prognosis
The diseases run a chronic course
with persistence or recurrence of
lesions. Exacerbations occur in
response to emotional stress.

THANK
YOU

References
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normalpopulation: A study of pruritus. Eur J Dermatol. 2010; 20(3): 359-63
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References
Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 5th edition.

Philadelphia: Mosby; 2010. p.115-9.

Rubakovic, Steffen. Dermatopathology in Historical Perspective: The Montgomery Giant
Cell of Lichen Simplex Chronicus. Skin Med. 2010 January; 8(1): 54-5.
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Paller AS, Leffell DJ, eds. Fitspatrickss Dermatology In General Medicine. 8th ed. New
York: The McGraw-Hill Companies, Inc.; 2012. p. 208-16.
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BA, Paller AS, Leffell DJ, eds. Fitspatrickss Dermatology In General Medicine. 8th ed.
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Kim, Lockey. Dermatology for the Allergist: Lichen Simplex Chronicus. USA: World
Allergy Organization; 2010. p. 212-213.

Emotion related lichen simplex

chronics
Whether these emotional factors are

secondary to the primary dermatologic

disease or whether they are primary and
causative, altering perception of itch, is
unclear. It has been postulated that
neurotransmitters that affect mood, such as
dopamine, serotonin, or opioid peptides
modulate perception of itch via descending
spinal pathways