Lichen Simplex Research Articles

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.

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. 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. 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. 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.

Diagnostic utility of Ki-67 and Cyclin D1 immunostaining in differentiation of psoriasis vs. other psoriasiform dermatitis

Background:Differentiation of psoriasis from non-psoriasis psoriasiform dermatitis (NPPD) may be difficult for dermatopathologists, as lack of distinctive histopathological features in a subset of cases may cause confusion in diagnosis.Objective:As the prototype of psoriasiform dermatitis, psoriasis is a hyperproliferative skin disorder with increased epidermal turnover compared with NPPD, we investigated the role of proliferation markers, Ki-67 and Cyclin D1 as diagnostic tools to differentiate psoriasis from other psoriasiform dermatitis.Methods:Histopathological specimens of psoriasis (n = 35) and NPPD (n = 36, 14 pityriasis rubra pilaris, 12 pityriasis rosea and 10 lichen simplex) cases were reviewed and immunohistochemically stained for Ki-67 and Cyclin D1. Ki-67 and Cyclin D1 positive cells were counted for suprabasal, and total epidermal immunostaining per mm2.Results:Suprabasal and total epidermal cell counts for Ki-67 were found to be significantly higher in the psoriasis group compared with the NPPD group (p < 0.05). An important and interesting feature was the presence of a cut-off value for the suprabasal/total epidermal cell count ratio of 75% for Ki-67 immunostaining, which was higher in all patients having psoriasis (range, 77.1% – 92.4%) and lower in all NPPD cases (range, 21.0% – 73.3%). However, suprabasal Cyclin D1 cell counts were higher in the psoriasis group compared with the NPPD group (p < 0.05), total epidermal Cyclin D1 cell counts were not statistically significant in either group (p = 0.167), and a cut-off value for suprabasal/total epidermal cell count ratio to distinguish these two entities was not detected using this immunostain.Conclusions:We suggest that Ki-67 is a more sensitive marker than Cyclin D1 in terms of having a cutoff value of 75% for the suprabasal/total epidermal immunoreactive cell count ratio, which we believe could be useful for dermatopathologists in differentiating psoriasis from other psoriasiform dermatitis.

Vulvar dermatoses: a histopathologic review and classification of 183 cases.

Vulvar dermatoses are often difficult to classify due to histopathologic overlap. We aimed to report our experience at a single institution. A total of 183 non-neoplastic, non-infectious vulvar biopsies were reviewed. Associations between histopathologic features and specific diagnoses were analyzed by Chi-squared tests. Twenty-two biopsies (12.0%) showed two concurrent processes. A limited differential rather than a definitive diagnosis was rendered in 15 cases (8.2%). The final diagnoses included lichen sclerosus (LS) (38.8%), lichen simplex chronicus (LSC) (29.0%), eczematous dermatitis (23.0%), Zoon vulvitis (8.2%), non-specific/resolved dermatitis (5.5%), hidradenitis suppurativa (2.7%), Behçet disease (2.2%), lichen planus (1.6%), ruptured cyst (1.6%), ulcer not-otherwise-specified (1.6%), psoriasis (1.1%), radiation dermatitis (1.1%), sebopsoriasis (1.1%), seborrheic dermatitis (1.1%), epidermolytic hyperkeratosis (0.5%) and granular parakeratosis (0.5%). Early LS and Zoon vulvitis were commonly included as part of a differential diagnosis. LS was associated with wiry collagen with lymphocyte entrapment (p = 0.0188). LSC was associated with zones of pale epithelium (p = 0.0084), and often displayed prominent fibroblasts (p = 0.0555). Zoon vulvitis was frequently misdiagnosed, and was associated with basal keratinocytic crowding (p < 0.0001). Our study has determined the relative frequencies of a wide variety of vulvar dermatoses, and identified new diagnostic clues for early LS, LSC and Zoon vulvitis.

Lichen Simplex Chronicus Associated With Erectile Dysfunction: A Population-Based Retrospective Cohort Study.

BackgroundAn association between lichen simplex chronicus (LSC) and sexual dysfunction was explored. However, no data are available from investigations into the relationship between erectile dysfunction (ED) and LSC.ObjectivesThis retrospective population-based cohort study aimed to clarify the risk of ED associated with LSC.MethodsBy using the Taiwan National Health Insurance Research dataset, we identified 5611 male patients who had been newly diagnosed with LSC from 2000 to 2004. The date of diagnosis was identified as the index date. LSC patients with incomplete demographic information or with a history of ED before the index date were excluded. In total, 22444 age-matched patients without LSC were randomly selected as the non-LSC group based on a 1:4 ratio. Subsequence occurrence of ED was measured until 2011. The association between LSC and the risk of developing ED was estimated using Cox proportional hazard regression model.ResultsAfter adjusting for age and comorbidities, patients with LSC had a 1.74-fold greater risk of developing ED compared with those without LSC (95% confidence interval=1.44–2.10). LSC patients with comorbidities including diabetes, hyperlipidemia, hypertension, cardiovascular disease, peripheral arterial disease, chronic obstructive pulmonary disease, chronic kidney disease, depression, and anxiety were at a higher risk of ED compared with the non-LSC patients without comorbidities.ConclusionsLSC confers a greater risk in the development of ED. Physicians should be aware of the potential of ED occurrence in LSC patients.

Use of transcutaneous electrical nerve stimulation for chronic pruritus.

Pruritus is a distressing symptom in many dermatological as well as systemic conditions, and it is sometimes very chronic and relapsing. Transcutaneous electrical nerve stimulation (TENS) is an inexpensive form of analgesia that could also ameliorate itching. This study aimed to evaluate TENS efficacy in patients with pruritus due to some types of chronic eczema, and in patients with chronic hepatic disease. Ten patients with atopic dermatitis (AD), 20 patients with lichen simplex chronicus (LSC), and 16 patients with chronic liver disease having chronic distressing pruritus received three sessions of TENS weekly for 12 sessions, and the effect on the visual analogue scale (VAS) scores was recorded after 2 weeks of therapy, at treatment end, and after an additional month for follow up. There was a statistically significant decline in the mean VAS score for studied groups at weeks 2 and 4 of therapy compared to baseline, but the improvement was more significant in patients with AD, and LSC (p < 0.001 for both) than in those with chronic liver disease (p < 0.01) who also showed an early re-elevation of VAS score on follow up. TENS therapy holds promise as a palliative, alternative, safe and inexpensive treatment for patients with some chronic pruritic conditions.

Mammary and extramammary Paget's disease.

Paget's disease, described by Sir James Paget in 1874, is classified as mammary and extramammary. The mammary type is rare and often associated with intraductal cancer (93-100% of cases). It is more prevalent in postmenopausal women and it appears as an eczematoid, erythematous, moist or crusted lesion, with or without fine scaling, infiltration and inversion of the nipple. It must be distinguished from erosive adenomatosis of the nipple, cutaneous extension of breast carcinoma, psoriasis, atopic dermatitis, contact dermatitis, chronic eczema, lactiferous ducts ectasia, Bowen's disease, basal cell carcinoma, melanoma and intraductal papilloma. Diagnosis is histological and prognosis and treatment depend on the type of underlying breast cancer. Extramammary Paget's disease is considered an adenocarcinoma originating from the skin or skin appendages in areas with apocrine glands. The primary location is the vulvar area, followed by the perianal region, scrotum, penis and axillae. It starts as an erythematous plaque of indolent growth, with well-defined edges, fine scaling, excoriations, exulcerations and lichenification. In most cases it is not associated with cancer, although there are publications linking it to tumors of the vulva, vagina, cervix and corpus uteri, bladder, ovary, gallbladder, liver, breast, colon and rectum. Differential diagnoses are candidiasis, psoriasis and chronic lichen simplex. Histopathology confirms the diagnosis. Before treatment begins, associated malignancies should be investigated. Surgical excision and micrographic surgery are the best treatment options, although recurrences are frequent.

Perianal lichen dermatoses: A review of 60 cases.

To determine the diagnostic range of lichen dermatoses of the perianus, their extent, and response to treatment. We reviewed perianal biopsies submitted to a tertiary referral pathology service between January 2010 and July 2014, interpreted as 'lichen' or 'lichenoid'. We collected data on patients' characteristics, referring specialty, extent of lesion and response to treatment. During the study period, 60 perianal biopsies met our inclusion criteria. The distribution of diagnoses was lichen sclerosus (LS) in 25/60 (42%), lichen simplex chronicus (LSC) in 23/60 (38%), lichen planus (LP) in 10/60 (17%), and a non-specific lichenoid reaction in 2/60 (3%). Eleven of 25 cases of LS (44%) showed superimposed LSC. Of 10 LP cases, nine (90%) were hypertrophic and three of these showed pseudoepitheliomatous hyperplasia; none were erosive LP. Compared with patients in the LS and LSC groups, those with LP were more likely to have a localised lesion. Topical steroids were prescribed in 91% cases with treatment data available, and 98% of treated patients who returned for follow up had improved or their disease was resolved. We encountered a spectrum of perianal lichen dermatoses, with LS, LP and LSC all represented. LS biopsied at the perianus is often lichenified. Hypertrophic LP is a common form of LP at the perianus.

Quality of life and obsessive‐compulsive behavior in patients with lichen simplex chronicus

JDDG: Journal der Deutschen Dermatologischen GesellschaftVolume 13, Issue 2 p. 162-163 Clinical Letter Quality of life and obsessive-compulsive behavior in patients with lichen simplex chronicus First published: 29 January 2015 https://doi.org/10.1111/ddg.12465 Correspondence to Anargyros Kouris M.D., M.Sc Kolokotroni 11 Post code: 14569 Athens, Greece E-mail: kouris2007@yahoo.com AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume13, Issue2February 2015Pages 162-163 RelatedInformation

Vulvar Dermatoses: Effect of a Synergistic Treatment with a Moisturizing and Healing Product on the Course of the Disease

Background: Vulvar dermatoses are inflammatory disorders of genital skin causing itch, burning, and plaques with overlying excoriation and linear fissures. Objective: To assess the effectiveness of a soft foam based on Tiab® system (TF), complex of titanium micro crystals covalently bound with silver ions associated with hyaluronic acid, in the supportive treatment of lichen sclerosus (LS) and lichen simplex chronicus (LSC), the two common vulvar dermatoses. Method: 20 patients with the diagnosis of LS or LSC received an 4-week treatment, during which the subjects applied Mometasone furoate in the form 0.1% cream were treated with Mometasone furoate 0.1% cream in combination with TF once a day. Clinical symptoms (itching and burning) and signs (vulvar suface disruption) were documented at baseline and at the end of the four-week treatment. Results: There was a significant reduction of symptoms between the basal scores and the symptoms complaints at 4-week treatment. Moreover, a significant reduction of excoriations and linear fissures was observed. Conclusion: The present study shows that daily application of TF can be an effective adjunct for the treatment of vulvar dermatosis. The foam had not only a moisturizer action, it may also be associated with a reduction in epithelial disruption in the form of excoriations and fissures.

Zinc-responsive acral hyperkeratotic dermatosis-A novel entity or a subset of some well-known dermatosis?

Background:We are reporting a series of interesting cases, which presented to us with psoriasiform lesions distributed over the acral regions of the body. The cases are unusual because they were resistant to conventional treatment modalities like topical corticosteroids, tacrolimus and oral methotrexate but showed significant improvement on oral zinc therapy.Materials and Methods:Ten patients with characteristic clinical features of distinctive hyperkeratotic plaque in the acral areas, who were resistant to treatment by different modalities including potent topical steroids and oral methotrexate, were included for detailed investigations. A proper history was taken and relevant laboratory investigations were done which included blood count, urine, liver function, renal function, hepatitis-C virus serology and serum zinc levels. Patients were followed up every 2 weeks. Histopathological examinations of the lesional tissue were done at baseline and after 6 weeks of therapy. Patients were given oral zinc daily and no other treatment during the 6 weeks course.Results:All our patients were non-reactive to hepatitis-C. Of the ten patients only one patient (10%) showed low titer of serum zinc, another (10%) showed higher zinc level, while the rest of the patients had normal zinc level. Five of our patients had chronic renal failure, one had Grave's disease and the remaining had no associated systemic illness. Histopathology mostly showed hyperkeratosis, acanthosis, prominent granular layer, spongiosis and dermal infiltrate. After 6 weeks of follow up, all patients showed rapid and remarkable therapeutic response with zinc.Conclusions:We here report a series of patients, discernible because of their uniform clinical presentation of acral hypekeratotic plaques and in showing a noticeable response to zinc. Clinical, histopathological and laboratory investigations were done to rule out diseases of similar morphology including psoriasis, acral necrolytic erythema and lichen simplex chronicus. Authors understand that further studies with greater number cases and more detailed investigations are required to establish exact etio-pathogenesis and nomenclature of this distinct subset of patients.

Hypertrophic lichen planus-like atopic dermatitis: a case report

Results The lesions started at age 18 during the patient s first pregnancy and had a predominant flexural distribution pattern. At the physical exam, the patient presented with erythema and infiltrative lesions in forearm and periorbital regions, and scaly erythematous papules, especially in inferior extremities. Some of these lesions presented an ulcerous center and had linear form. The patient had high specific serum IgE levels for house dust mites (Dermatophagoides farinae and D. pteronyssinus), grass and dog; sea food, fish, soy, wheat and latex. Serum total IgE was 11,100kU/L, and serology for hepatitis B and C was negative. The patient was treated with antihistamines, topical emollients and oral corticosteroids with low improvement. Because of this atypical presentation, other differential diagnoses were considered, including hypertrophic lichen planus. Skin biopsy was performed, showing hyperkeratosis, sub-acute spongiotic dermatitis and moderate acanthosis, compatible with atopic dermatitis and an evolution to lichen simplex chronicus. Conclusions Hypertrophic lichen planus is one of the differential diagnosis of atopic dermatitis and it commonly involves the flexor surfaces of the extremities bilaterally. Adultonset AD can present with non-typical morphology and localization, therefore it is important to distinguish these two entities, since lichen planus can be associated with other diseases, such as viral hepatitis.

Study of the Dermoscopic Findings and Their Correlation with Histopathological Findings in Various Lichenoid Dermatoses

Abstract Background: Lichenoid disorders are often difficult to diagnose clinically. Dermoscopy can act as an alternative technique to skin biopsy for diagnosis of various lichenoid dermatoses. Study aim: To study the correlation of dermoscopic with histopathological findings in various lichenoid dermatoses Methods: Fifty patients with clinical picture of lichenoid dermatoses were examined first under the dermoscope, followed by skin biopsy from the same site. The findings of both methods were recorded and correlated. Results: Nonvascular findings were the predominant features on dermoscopy out of which white structures were present in 93.33% of patients of classical lichen planus, 50% of actinic lichen planus, 90% of lichen planus hypertrophicus, 50% of lichen planopilaris and in only the case of lichen simplex chronicus. In classical lichen planus patients, a particular pattern of white structures with linear streaks arranged in a radial manner (starburst pattern) was observed. In lichen planus, it is suggested that the white structures on dermoscopy corresponded histologically to hyperkeratosis. Gray-blue dots or brown punctate areas represented melanophages in dermis. In lichen planus pigmentosus and ashy dermatosis patients, no specific patterns could be observed. In lichen planus hypertrophicus, white structures, corn pearls and comedolike openings appeared to represent hyperkeratosis and hypergranulosis, while pigmentation of variable colors could be due to presence of melanophages in the dermis. Conclusion: Dermoscopy can be a valuable tool for the dermatological diagnosis and may obviate need for skin biopsy.

Hypertrophic lichen sclerosus sine sclerosis: clues to histopathologic diagnosis when presenting as psoriasiform lichenoid dermatitis.

The histopathologic diagnosis of lichen sclerosus (LS) is usually facilitated by a subepidermal zone of sclerosis. In the absence of sclerosis, LS mostly presents itself as a psoriasiform lichenoid dermatitis that may be difficult to distinguish from other diseases. We sought to assess histopathologic findings that allow recognition of LS in the absence of sclerosis. We studied 28 criteria in 100 biopsy specimens of LS from genital or perianal skin, including 55 cases with marked sclerosis, 16 cases with mild sclerosis confined to foci of the papillary dermis and 29 cases without sclerosis. Fifteen cases each of the early plaque stage of mycosis fungoides, lichen planus and lichen simplex chronicus were studied for comparison. Some histopathologic hallmarks of LS were seen chiefly in sclerotic lesions and, therefore, did not contribute to the diagnosis of difficult cases, such as dissolution of elastic fibers. Others were seen rarely in non-sclerotic lesions but might be helpful in individual cases, including follicular hyperkeratosis and thickening of the basement membrane. Findings that were more common and may be utilized as clues to the histopathologic diagnosis of non-sclerotic LS include tiny foci of homogenized tissue in dermal papillae, marked fibrosis with thickening of the papillary dermis, marked thickening of individual collagen fibers, lymphocytes aligned in rows between those fibers, necrotic keratinocytes, often with preserved pyknotic nuclei, in all reaches of the epidermis, including the cornified layer, clustering of necrotic keratinocytes above elongated dermal papillae and vertical columns of parakeratosis with distinct dyskeratotic parakeratotic cells. In the absence of sclerosis, histopathologic diagnosis of LS depends on findings that are less distinctive. Nonetheless, a constellation of those findings allows a specific diagnosis to be made.

Famous lines in history: Blaschko lines.

The lines of Blaschko describe a linear pattern of distribution of various congenital, nevoid, andacquiredskindisorderswith their suspectedembryological origins not yet well understood. These lines were painstakingly and thoroughly documented first by German dermatologist AlfredBlaschko.Blaschkowas the sonof aphysician andwasborn in 1858 in Freienwalde and died in 1922 in Berlin. He was a private practitioner in Berlin, where his dermatologic interests ranged from dermatitis herpetiformis, leprosy, and, later in his career, occupational skin diseases to social hygiene and venereal diseases. Blaschko studied the distribution of various nevoid disorders, such as epidermal and sebaceous nevi, aswell as acquired disorders, such as linear psoriasis, eczema, lichen planus, lichen simplex chronicus, and scleroderma. He transposed the pattern of these lesions in more than 140 patients onto dolls and statues and eventually produced complete illustrations of his famous lines all over thebody.His findingswere published in 1901 as a supplement to the Proceedings of the German Dermatological Society’smeeting held inBreslau that year. Thepublication included 26 pages of hand drawings, the first 9 of which were illustrations of herpes zoster. Although we now know that zoster follows the distributionof cutaneousdermatomesandnotBlaschko lines, the2distributions were commonly confused at the time. In 1902, Blaschko helped in the founding of the German Society for the Fight against Venereal Diseases alongwith Albert Neisser, a leading expert in venereology and the discoverer of theNeisseria gonorrhoeae bacterium. He served as general secretary for the organization and led efforts to educate the public regarding venereal diseases by distributing pamphlets and leaflets, organizing lectures all over the country, offering seminars for teachers, and lobbying for sex education in classes. After reviewingBlaschko’swritingsduringthis time,RobertJackson,who in 1976 published a detailed review of Blaschko’s seminal findings, suggests hewas perhaps among the first advocates of thewomen’s liberationmovement. For instance, inanaddress in 1903Blaschkoargued that the best form of prophylaxis against venereal disease was improvement of the economic condition of women, which would only be possible in agenuinely freeanddemocratic state. In 1913, he counteredprevious legislative efforts to ban advertising for contraceptives by calling these efforts extremely dangerous, and championed the “recommendationofprophylacticsuntil thewholepopulation is fully informed from the onset of puberty.” Clearly,Blaschko’s legacy isas impressive forhisdiligentworkasadermatologistandeminenteyeforpatternrecognitionasit isforhiscourageous championing of social health reforms at the turn of the 20th century.

Autofluorescence analysis of dermatitis and squamous cell carcinoma in paraffin wax-embedded skin samples

Recent research has investigated the use of autofluorescence (AF) for distinguishing between normal and cancerous tissues according to different fluorescence characteristics. To analyze if AF can help differentiate cancerous lesions from other nonneoplastic lesions, such as dermatitis, in each layer of the skin ex vivo. Paraffin wax-embedded tissue samples were obtained from patients who were histopathologically diagnosed with squamous cell carcinoma (SCC), psoriasis, chronic dermatitis (lichen simplex chronicus, prurigo nodularis) or acute dermatitis (atopic dermatitis). AF intensity was measured in four layers of the epidermis (corneal, granular, spinous and basal) and two layers of the dermis (papillary and reticular). AF was highest in all layers of psoriasis samples compared with all layers of all other groups. Higher AF values were seen in SCC compared with all skin layers of acute and chronic dermatitis; this finding was especially true in the corneal layer, papillary dermis and reticular dermis. This ex vivo AF study provides basic data for future in vivo studies of AF as a noninvasive diagnostic tool.

Vulval pruritus: The experience of gynaecologists revealed by biopsy

Pruritus of the vulva is a common symptom among patients attending to outpatient clinics. In the present study, we aimed to assess pathologies causing vulval pruritus in the reliability of biopsy in a tertiary referral centre. A total of 137 patients undergoing vulval colposcopy because of vulval pruritus were reviewed from the hospital records retrospectively. The mean age of the patients was 47.61 ± 11.88 years and 36.5% of the patients were postmenopausal. In 101 (73.7%) of the patients, macroscopic lesions were present. In 88 (64.2%) of the patients, tolidine-positive stained areas were determined under colposcopy. In total, 68 (49.6%) of the lesions were plain, whereas 51 (37.2%) of them were depigmented. Lichen simplex chronicus, lichen sclerosis and chronic inflammation were the major pathologies associated with vulval pruritus (25.5%, n = 35; 20.4%, n = 28; 14.6%, n = 20). In conclusion, several pathologies out of vulvovaginal candidiasis may lead to vulval pruritus and clinicians should be aware of the importance of biopsy in determining the underlying pathology.

Diagnosing rashes, part 10: Linear skin rashes

Practice NursingVol. 25, No. 7 DermatologyDiagnosing rashes, part 10: Linear skin rashesJean WatkinsJean WatkinsSearch for more papers by this authorJean WatkinsPublished Online:1 Jul 2014https://doi.org/10.12968/pnur.2014.25.7.344AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Adler G (2014) Cushing syndrome. http://tinyurl.com/lj2b8yk (accessed 14 June 2014) Google ScholarAlaiti S (2014) Striae distensae. http://tinyurl.com/ley3olu (accessed 14 June 2014) Google ScholarBaugh W (2012) Phytophotodermetitis. http://tinyurl.com/2eg6shv (accessed 20 June 2014) Google ScholarChuang T (2014) Lichen planus. http://emedicine.medscape.com/article/1123213-overview (accessed 26 June 2014) Google ScholarClark C (2010) Psoriasis. http://www.netdoctor.co.uk/diseases/facts/psoriasis.htm (accessed 26 June 2014) Google ScholarDermNet NZ (2013) Viral warts. http://dermnetnz.org/viral/viralwarts.html (accessed 26 June 2014) Google ScholarGroysman V (2014) Vitiligo. http://emedicine.medscape.com/article/1068962-overview (accessed 26 June 2014) Google ScholarHogan D (2012) Lichen simplex chronicus. http://emedicine.medscape.com/article/1123423 (accessed 20 June 2014) Google ScholarJanniger C (2014) Herpes zoster. http://emedicine.medscape.com/article/1132465-overview(accessed 20 June 2014) Google ScholarJoint Formulary Committee (2014) British National Formulary 67. March. BMJ Group and Pharmaceutical Press, London Google ScholarKim J (2014) Lichen striatus. http://tinyurl.com/pofzy4 (accessed 20 June 2014) Google ScholarLaube S (2014) Dermographism urticaria. http://emedicine.medscape.com/article/1050294 (accessed 20 June 2014) Google ScholarNgan V (2014) Epidermal naevi. http://www.dermnetnz.org/lesions/epidermal-naevi.html (accessed 20 June 2014) Google ScholarNguyen JV (2012) Morphea. http://emedicine.medscape.com/article/1065782 (accessed 20 June 2014) Google ScholarTallon B (2013) Flagellate erythema. http://www.dermnetnz.org/reactions/flagellate.html (accessed 23 June 2014) Google ScholarTidy C (2011) Cutaneous larva migrans. http://www.patient.co.uk/doctor/Cutaneous-Larva-Migrans.htm (accessed 23 June 2014) Google ScholarWillacy H (2012) Epidermal naevus and its syndromes. http://www.patient.co.uk/doctor/Epidermal-Naevus.htm (accessed 20 June 2014) Google Scholar FiguresReferencesRelatedDetails 2 July 2014Volume 25Issue 7ISSN (print): 0964-9271ISSN (online): 2052-2940 Metrics History Received 27 March 2014 Accepted 4 April 2014 Published online 1 July 2014 Published in print 2 July 2014 Information© MA Healthcare LimitedKeywordsAnnular rasheslesionsdifferential diagnosismanagementtreatmentPDF download

The impact of disease information and behaviour development on the treatment of lichen simplex chronicus

The impact of disease information and behaviour development on the treatment of lichen simplex chronicus

Increased risk of lichen simplex chronicus in people with anxiety disorder: a nationwide population-based retrospective cohort study

The cingulate cortex is the main area in the brain involved in pruritus processing and is deactivated after scratching. Lichen simplex chronicus (LSC) is a common pruritic skin disorder characterized by skin lichenification following excessive scratching. Psychological factors may contribute to both the development and persistence of LSC. To estimate the hazard ratio (HR) of LSC in people with anxiety disorders compared with the general population. In this nationwide population-based retrospective cohort study we identified a total of 69386 people, who formed the anxiety cohort, by using the Taiwan National Health Insurance Research Database from 2000 to 2009. The comparison cohort was composed of randomly selected people frequency matched for age (within 5-year intervals), sex and index date (the date of anxiety diagnosis) based on a 1:2 ratio. The risk of LSC was estimated as HRs and 95% confidence intervals (CIs) using the Cox proportional hazards model. After adjusting for age, sex and LSC-associated comorbidities, the people with anxiety had a 1·41-fold greater risk of developing LSC compared with the people in the comparison cohort (HR 1·41, 95% CI 1·30-1·52, P<0·0001). In particular, individuals with obsessive-compulsive disorder had a significantly increased risk of developing LSC (HR 1·72, 95% CI 1·03-2·88, P=0·0395). This study demonstrates that having an anxiety disorder is associated with an increased risk of LSC. Psychological factors were found to contribute to LSC. We recommend combining the management of LSC and psychological disorders to achieve favourable outcomes.

Phototherapy for vulvar lichen simplex chronicus: an ‘off‐label use’ of a comb light device

Photodermatology, Photoimmunology & PhotomedicineVolume 30, Issue 6 p. 332-334 LETTER TO THE EDITOR Phototherapy for vulvar lichen simplex chronicus: an ‘off-label use’ of a comb light device Annarosa Virgili, Corresponding Author Annarosa Virgili Dermatology Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy Correspondence: Prof Annarosa Virgili, MD, Dermatology Section, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44100 Ferrara, Italy. Tel: +39 0532/205825 Fax: +39 0532/206791 e-mail: [email protected]Search for more papers by this authorSara Minghetti, Sara Minghetti Dermatology Section, Department of Medical Sciences, University of Ferrara, Ferrara, ItalySearch for more papers by this authorAlessandro Borghi, Alessandro Borghi Dermatology Section, Department of Medical Sciences, University of Ferrara, Ferrara, ItalySearch for more papers by this authorMonica Corazza, Monica Corazza Dermatology Section, Department of Medical Sciences, University of Ferrara, Ferrara, ItalySearch for more papers by this author Annarosa Virgili, Corresponding Author Annarosa Virgili Dermatology Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy Correspondence: Prof Annarosa Virgili, MD, Dermatology Section, Department of Medical Sciences, University of Ferrara, Via Savonarola 9, 44100 Ferrara, Italy. Tel: +39 0532/205825 Fax: +39 0532/206791 e-mail: [email protected]Search for more papers by this authorSara Minghetti, Sara Minghetti Dermatology Section, Department of Medical Sciences, University of Ferrara, Ferrara, ItalySearch for more papers by this authorAlessandro Borghi, Alessandro Borghi Dermatology Section, Department of Medical Sciences, University of Ferrara, Ferrara, ItalySearch for more papers by this authorMonica Corazza, Monica Corazza Dermatology Section, Department of Medical Sciences, University of Ferrara, Ferrara, ItalySearch for more papers by this author First published: 03 March 2014 https://doi.org/10.1111/phpp.12120Citations: 9 Conflicts of interest: None declared. Financial disclosure: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume30, Issue6December 2014Pages 332-334 RelatedInformation