Lichen Simplex Research Articles

DEVIL, VAAD and vLSC constitute a spectrum of HPV-independent, p53-independent intra-epithelial neoplasia of the vulva.

We aimed to characterise a large cohort of non-invasive, human papillomavirus (HPV) and p53-independent verruciform lesions, such as 'vulvar acanthosis with altered differentiation' (VAAD), 'differentiated exophytic vulvar intra-epithelial lesion' (DEVIL) and 'verruciform lichen simplex chronicus' (vLSC). From January 2008 to December 2020 we retrospectively identified 36 eligible patients with verruciform non-invasive lesions (n = 36) and collected clinical, histological and follow-up parameters. Verruciform non-invasive lesions occurred at a median age of 71 years, with a median follow-up of 33.5 months. Clinically, pruritus was only reported in patients with VAAD (n = 3, 21%). Lesion colour was significantly different across categories (P = 0.028). Apart from the histopathological criteria already known to distinguish these entities (hypogranulosis, epithelial pallor and low-magnification architecture), no other significant criteria were discovered and significant overlap was observed, particularly between VAAD and DEVIL. Patients with vLSC trended towards longer survival without recurrence compared to VAAD and DEVIL (P = 0.082), but showed comparable invasion-free survival interval (P = 0.782). Squamous cell carcinomas (SCC) associated with either VAAD, DEVIL or vLSC displayed similar clinical, histopathological and biological parameters. In non-invasive precursor lesions, stromal oedema was associated with invasion (P = 0.015) and remained so upon Cox regression analysis (P = 0.009). Our study of HPV and p53 independent non-invasive verruciform lesions of the vulva highlights significant clinical, histopathological and biological overlap between VAAD, DEVIL and vLSC, suggesting that these pre-invasive lesions should be viewed as a spectrum. We also show that stromal features such as oedema might play an import role in progression to invasion.

Itch in Lichen Simplex Chronicus Is Associated with Localized Small Fiber Neuropathy

Lichen simplex chronicus (LSC) is a common pruritic condition of unknown pathophysiology. The sensory innervation of the skin consists of a dermal plexus formed by myelinated and unmyelinated fibers. The epidermis only contains unmyelinated fibers, which signal temperature, pain, and/or itch (Ikoma et al., 2006). Intraepidermal fibers can be visualized using the marker PGP 9.5, a ubiquitin C-terminal hydrolase, which is abundantly present in the nervous system (Lauria et al., 2010). Studies of conditions associated with chronic itch have reported increased or decreased intraepidermal nerve fiber density (prurigo nodularis [Johansson et al., 2000; Schuhknecht et al., 2011], amyloidosis [Tey et al., 2016], or epidermolysis bullosa [von Bischhoffshausen et al., 2017]).

Interobserver reproducibility of the diagnosis of differentiated exophytic vulvar intraepithelial lesion (DEVIL) and the distinction from its mimics.

Most vulvar squamous cell carcinomas are human papillomavirus (HPV)-associated or TP53-mutant. A third category of HPV-independent TP53-wild-type lesions is uncommon and not fully understood. Differentiated exophytic vulvar intraepithelial lesion (DEVIL) has been characterised as a precursor of this latter category. The reproducibility of the diagnosis of DEVIL and its distinction from lesions with overlapping morphology has not been studied. Our aim was to establish the interobserver agreement in the diagnosis of DEVIL and its distinction from neoplastic and reactive conditions of the vulva on haematoxylin and eosin evaluation. A set of 35 slides was evaluated by eight reviewers (two trainees and six practising gynaecological pathologists). The set included DEVIL, condyloma, established vulvar precursors [high-grade squamous intraepithelial lesion (HSIL) and differentiated vulvar intraepithelial neoplasia (dVIN)] with superimposed acanthosis or verruciform growth, lichen simplex chronicus (LSC), and psoriasis. Kappa (κ) values were calculated. Overall, interobserver agreement was moderate (κ = 0.56), improving to substantial (κ = 0.7) when evaluation was performed by practising pathologists. Agreement was strong for the diagnosis of HSIL (κ = 0.88), and substantial for the diagnosis of DEVIL (κ = 0.61), condyloma (κ = 0.79), and LSC (κ = 0.72). Agreement was moderate for the diagnosis of dVIN (κ = 0.59) and psoriasis (κ = 0.53). Perfect agreement (6/6) among practising pathologists was observed in 43% of cases, and majority agreement (5/6 or 4/6) was observed in 48% of cases. Reproducibility in the diagnosis of verruciform vulvar lesions, including the novel DEVIL, is acceptable overall. Reproducibility is higher for well-known lesions such as HSIL and condyloma than for more challenging diagnoses such as DEVIL, dVIN, and psoriasis. Agreement is higher among practising gynaecological pathologists, suggesting that training and experience improve reproducibility. Our findings support the inclusion of DEVIL as a diagnostic entity in the classification of vulvar squamous lesions.

Keratin 17 is Not Always a Marker of Proliferation of Keratinocytes in Skin Diseases.

PurposeKeratin 17 (K17) is an embryonic keratin and overexpression is seen in psoriasis, which is a hyperproliferation skin disease. Nonetheless, whether it is also highly expressed in other proliferative skin diseases remains unclear. The aim of this study is to explore the expression of K17 in cutaneous lichen planus (CLP), lichen simplex chronicus (LSC), and prurigo nodularis (PN).MethodsA total of 20 skin samples from CLP lesions, 20 from LSC lesions, 20 from PN lesions, and 10 healthy adult skin tissues were obtained. Then, the expression of K17 was analyzed using immunohistochemistry on paraffin-embedded tissue sections. Furthermore, quantitative and semi-quantitative immunohistochemical scores of K17 were independently evaluated under a microscope by 2 dermatologists.ResultsImmunohistochemical analysis revealed that in normal skin, K17 was minimally expressed. Nevertheless, it was highly expressed in all epidermal layers in CLP lesions (P-value <0.01), and negatively expressed in LSC and PN lesions (all P-value >0.05). The average gray value of K17 in CLP was 151.153±13.985 (P-value <0.001), while the average values of K17 in LSC and PN were 178.720±12.001 and 181.316±8.920, respectively (all P-value >0.05).ConclusionK17 is potentially expressed in certain inflammatory skin diseases, including psoriasis and lichen planus. Besides, it is not always a marker of hyperproliferation of keratinocytes in skin diseases.

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

SummaryScalp 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.

Lichen Simplex Chronicus in Psychological Aspects

Lichen simplex chronicus (LSC) is an eczematous skin condition characterized by thickened and 'lichenified' skin plaques. The involvement of psychological variables and transitory alleviation of pruritus following vigorous scratching appears to be critical in the development and maintenance of its course. Studies and literatures have described the relationship between skin lesions exacerbation and level of psychopathological conditions in response to stress. Pruritus or itch is the most prominent symptom of LSC, which seems to have a marked psychological component. Psychological factors may have a role in both the onset and persistence of this form of neurodermatitis.

Efficacy and Safety of Liquid Nitrogen Cryotherapy for Lichen Simplex Chronicus: A Meta-Analysis

Background: Lichen simplex chronicus (LSC) is characterized by localized lichenification and intense itching. It has been reported that the added use of liquid nitrogen cryotherapy (LNC) for LSC has significant efficacy and notable safety. Therefore, we conducted a meta-analysis based on existing randomized controlled trials (RCTs). Method: We searched RCTs on LNC for LSC published up to August 2020 using various databases, including PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, China Network Knowledge Infrastructure (CNKI), Chinese Biomedicine (CBM), Chinese Scientific Journals Database (VIP), and WanFang Database. Other studies were manually identified using the references cited in reviews. We applied fixed- or random-effects models, and all analyses were performed using Review Manager 5.4 software. Results: Twelve RCTs involving 1,066 participants provided eligible data for the meta-analysis. Based on the clinical effective rate, LNC treatment of LSC (risk ratio, RR 1.25, p = 0.005, I² = 82%) was superior to controls. Subgroup analysis showed that the use of LNC alone (RR 1.04, I² = 95%, p > 0.05) is not more effective than other therapies in the treatment of LSC, but the addition of LNC to the existing treatment increases the total clinical efficacy. Furthermore, the combined effect of LNC and topical medication (RR 1.39, I² = 0%, p < 0.0001) was better than that of LNC and oral medication (RR 1.30, I² = 0%, p < 0.00001). Greater frequency of LNC treatment did not improve the efficacy (thrice a week: RR 1.39 [1.21, 1.60]; twice a week: RR 1.27; once every 2 weeks: RR 1.32). Data from 6 RCTs with 508 participants showed no significant difference in AEs (p = 0.31) associated with added LNC treatment. Conclusion: The addition of LNC (applying a cotton swab soaked with liquid nitrogen to wipe the lesion for approximately 10 s each time) to topical ointments, is effective and safe in the treatment of LSC. Increasing the treatment frequency of LNC did not necessarily improve the efficacy.

Interleukin 36 expression in psoriasis variants and other dermatologic diseases with psoriasis-like histopathologic features.

Elevated epidermal interleukin (IL)-36 expression distinguishes psoriasis from eczematous dermatitis, but other psoriasiform dermatitides (PDs) have not been thoroughly investigated for IL-36 expression. In this study, we assess the IL-36 staining pattern (IL36-SP) in psoriasis variants and other PDs including lichen simplex chronicus (LSC), prurigo nodularis (PN), lichen planus (LP), tinea, pityriasis rubra pilaris (PRP), mycosis fungoides (MF), pemphigus foliaceus (PF), acute generalized exanthematous pustulosis (AGEP), impetigo (IMP), and syphilis (SY). IL-36 immunostaining was performed on 307 cases of psoriasis and various PDs. IL36-SP in the upper epidermis was graded on a scale of 0-4. High IL36-SP occurred in all variants of psoriasis, as well as in AGEP, PRP, PN, tinea, IMP, and LP (P > 0.05). SY, PF, LSC, and MF showed a lower IL36-SP (P≤ 0.05) compared with psoriasis. All variants of psoriasis exhibit high IL36-SP. IL-36 staining can assist in differentiating MF, PF, SY, and LSC from psoriasis, particularly MF and LSC, which have consistent low IL-36 expression. AGEP, PRP, tinea, IMP, PN, and LP exhibit high IL-36 expression similar to psoriasis, indicating Th17 activation in these diseases.

Prevalence of eczema among older persons: A population-based cross-sectional study.

Background There are very few population-based studies on the prevalence of eczema among older persons Aims To estimate the prevalence and types of eczema in those aged 65 years or more in the community and to evaluate the effectiveness of community-based interventions for case finding. Methods In the first stage of this cross-sectional survey, trained health workers of a non-governmental organization surveyed the eligible population and identified persons likely to have eczema. In the second stage, dermatologists examined such persons to ascertain the diagnosis. Statistical analysis was done using Epi Info software version 7. Prevalence of eczema was expressed in percentages. Chi-square test was used for comparing the difference in prevalence of eczema in various age groups and sex. Results Health workers identified 98 persons as possible cases of eczema after interviewing 385 older persons in the community. Among them 95 persons were examined by dermatologists and 44 were confirmed to have eczema (diagnostic accuracy of health workers = 46.3%).Point prevalence of eczema was 11.4% (44/385). Prevalence was similar in males and females. It was greater (18.2 %) among persons aged 81 years or more. Asteatotic eczema, gravitational eczema and lichen simplex chronicus were the more common types of eczema. Limitations: Possible underestimation of the prevalence rates due to limited medical knowledge of health workers; limited facilities for examination and investigations at the medical camps and home visits. Conclusion There appears to be a considerable burden of eczema among older persons in the community. A community-based approach involving non-governmental organizations has the potential to identify cases and offer care close to their homes.

Selection of Anti-Depressants in Geriatric Dermatoses- A Questionnaire Study of Dermatologists in Western Rajasthan, India

Background: The Global Wealth Migration Review 2019 report, published by New World Wealth, estimated that 48% of India's total wealth was held by high-net worth individuals. Distinct factors dominate the prescription of anti-depressants in the geriatric population. Accordingly, the intention of pharmacotherapy in geriatric psycho dermatoses is deciphered in the study. . Objective: To survey and analyze the selection of anti-depressants by the dermatologists in the practice of geriatric pharmacotherapy. Methods: A questionnaire was designed and circulated among ninety-three dermatologists in three sessions and the data collected was analyzed through the cross-sectional study statistics. Results: The typical senior people attending the specialist were 25-50%. A sizeable familiarity of psycho cutaneous disturbance was attributed to dermatophyte infections, lichen simplex chronic, and Prurigo in descending order. The largely established primary disorder was neurotic excoriation. The prescription pattern was classified and 51.9% dermatologists are customary with psychotropic agent Doxepin over other agents. The discipline of the multidisciplinary approach was also studied. Limitation: Small sample size, uniregional study, prevalence study. Conclusions: The survey aids in evaluating mental health in cutaneous dermatoses of the elderly and assists the dermatologists to offer understated economical options and amend existing guidelines.

Understanding Dermatologic Concerns Among Persons Experiencing Homelessness: A Scoping Review and Discussion for Improved Delivery of Care.

There is a paucity of information surrounding dermatologic care for persons experiencing homelessness (PEH). This scoping review aims to map existing literature and provide a summary of the most common cutaneous manifestations among PEH, risk factors for dermatologic disease, describe any reported interventions, as well as identify research gaps for future studies. Search strategies developed for MEDLINE and hand searching yielded 486 articles. Out of the 486 articles screened, 93 articles met the inclusion criteria. The majority were cohort studies, cross-sectional studies, and case-control studies concentrated in North America and Europe. Excluding the pediatric population, the prevalence of dermatologic conditions ranged from 16.6% to 53.5%. Common skin conditions described in PEH were: acne, psoriasis, seborrheic dermatitis, atopic dermatitis, and lichen simplex chronicus. There were no studies comparing the extent or severity of these cutaneous diseases in PEH and the general population. PEH have a higher prevalence of skin infections and non-melanoma skin cancers. This scoping review has direct implications on public health interventions for PEH and highlights the need for evidence-based interventions to provide optimum and safe dermatologic healthcare for PEH. We propose several recommendations for improved care delivery, including addressing upstream factors and comorbidities impacting skin health, providing trauma informed care, reducing barriers to care, preventing and managing skin conditions, as well as including PEH in the planning and implementation of any proposed intervention.

Scabies-induced lichen simplex chronicus misdiagnosed as psychogenic pruritus: a case report

IntroductionLichen simplex chronicus has been defined as a localized skin condition characterized by thickening, hyperpigmentation and accentuated skin markings from chronic itching and from repeated scratching. The affected skin area is usually described as demarcated, and often circumscribed. It has even been defined as a “psychogenic pruritic disorder”. The idea of a neurological component has also been suggested, hence the term 'neurodermatitis circumscripta'. However, the pathophysiology of this condition remains unclear. Several associations and etiologies have been reported in literature, including strong links with mental disorders—anxiety and obsessive compulsive disorder to be specific. We report this case, most importantly, to highlight the value of an open-minded approach to patients and the 'old-fashioned' physician character of empathy, the skill of detailed history taking and physical examination, and lastly to suggest that lichen simplex chronicus may not always present as a localized, 'circumscripta' or demarcated area of skin.Case descriptionWhen a sixty-five year-old Caucasian female presented to our clinic agitated, intensely scratching her entire body and complaining of severe pruritus, an open-minded detailed approach during history taking and physical examination led to the working diagnosis of diffuse lichenification from chronic scratching secondary to a “possible” cutaneous disorder. Her medical history was unremarkable, but her psychiatric history was significant for Anxiety disorder. She remained on her anxiolytic medication. Her presenting symptom was reported to have persisted for more than 9 months. Review of previous unremarkable lab results and a remarkable findings on detailed skin inspection led to an empiric, trial regimen consisting of three topical preparations: an anti-pruritic—to break the itch-scratch cycle, anti-inflammatory—to curb any inflammatory/immune response and a 'last-ditch' scabicidal application. Follow-up was scheduled, but the patient called the office requesting an earlier follow up appointment. The lesions had significantly improved and the hyper-pigmented, indurated and escoriated skin appearance had resolved; and most importantly, the pruritus.ConclusionThus we conclude that lichen simplex chronicus may not always present as circumscribed or localized area of skin as currently noted in literature. Also, in patients with psychiatric conditions including anxiety and obsessive-compulsive disorder in particular, effort should be made to avoid stereotyping their presentation as part of their mental disorder spectrum. The value of detailed history and physical examination, mixed with empathy is highlighted. We make our recommendation considering the profound turnaround in the patient's condition and quality of life after several months of emotional and psychological suffering.

The role of homoeopathy in treating skin disease of the elderly: A case report

This is a case report of elderly man who was diagnosed with lichen simplex chronicus. He was treated using conventional medicine by dermatologists without any relief. Silicea, selected using the application of concept and technique of Boenninghausen’s approach after a study of the symptomatology, relieved the patient’s symptoms.

MANAGEMENT OF VICHARCHIKA (LICHEN SIMPLEX CHRONICUS) BY SHAMANA CHIKITSA: A CASE STUDY

In Ayurveda, most of the skin diseases are included under Kushtha. It can be classified into two groups which are Mahakushtha and Kshudrakushtha. Vicharchika is one among the Kshudrakushtha. According to classical texts, it can be characterised by Kandu (itching sensation), Shyava (blackish brown discolouration), Pidaka (eruptions), Bahusrava (excessive exudation), Raji (marked lining/lichenification), Atiruja (excessive pain) and Rukshata (dryness). Vicharchika can be correlated with Lichen Simplex Chronicus (LSC) based on its clinical presentation. LSC is a highly pruritic, circumscribed plaque or plaques of lichenified skin due to chronic scratching or rubbing. Vicharchika can be treated with Nidan parivarjana (Avoidance of etiological factors), Shodhana chikitsa (Purification therapy) and Shamana chikitsa (Palliative therapy). The present case study deals with a 45 years old male patient having complaints of severe itching in the palm of both hands associated with marked lining, dryness and thickened skin at the affected site for 5-6 months. This case is diagnosed as Vicharchika (Lichen Simplex Chronicus). For treatment Shamana chikitsa was administered for 1 month which showed good result.

Analysis of BCL-2 protein expression in keratinocytic hyperproliferative lesions

Apoptosis regulates keratinocytic proliferation and formation of stra-tum corneum in skin and is regulated by proteins like BCL-2 which con-trols cell survival and p53 which regulates cell death. Dysfunctional apoptosis plays an important role in development of hyperproliferative skin disorders including non-tumorigenic, pre-tumorigenic and tumor-igenic conditions. Therefore, we conducted a study to analyze the ex-pression pattern of apoptosis regulating protein BCL-2 in keratinocytic hyperproliferative lesions. The aim of this study was to evaluate and compare BCL-2 expression in various non-tumorigenic, pre-tumorigenic and tumorigenic keratinocytic hyperproliferative lesions. Skin biopsies of hyperproliferative keratinocytic lesions were studied from October 2018 to September 2020. The cases were categorized into 3 groups based on histological diagnosis (non-tumorigenic, pre-tumorigenic and tumorigenic). Following this, IHC for BCL-2 was performed on all cases using standard protocol. Tumorigenic lesions included 7 cases of SCC, pre-tumorigenic included 6 cases of seboherric keratosis, 2 cas-es of condyloma acuminata, 1 case of epidermodysplasia verruciform-is and 1 case of actinic keratosis, while the remaining 35 cases were non-tumorigenic, including psoriasis (6 cases), verruca vulgaris (4 cas-es), lichen planus (12 cases), chronic dermatitis (9 cases) and lichen simplex chronicus (4 cases). BCL-2 average weighted score in non-tumorigenic lesions was (1.25±1.13) as compared with pre-tumorigenic and tumorigenic lesions (5.30±3.32) and thus showing a significant p value (p&lt;0.001). To conclude, significantly increased BCL-2 expression in neoplastic lesions shows that increased cell survival may contribute to neoplastic transformation.

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.

Selection of Anti-Depressants in Geriatric Dermatoses- A Questionnaire Study of Dermatologists in Western Rajasthan, India

Background: The Global Wealth Migration Review 2019 report, published by New World Wealth, estimated that 48% of India's total wealth was held by high-net worth individuals. Distinct factors dominate the prescription of anti-depressants in the geriatric population. Accordingly, the intention of pharmacotherapy in geriatric psycho dermatoses is deciphered in the study. . Objective: To survey and analyze the selection of anti-depressants by the dermatologists in the practice of geriatric pharmacotherapy. Methods: A questionnaire was designed and circulated among ninety-three dermatologists in three sessions and the data collected was analyzed through the cross-sectional study statistics. Results: The typical senior people attending the specialist were 25-50%. A sizeable familiarity of psycho cutaneous disturbance was attributed to dermatophyte infections, lichen simplex chronic, and Prurigo in descending order. The largely established primary disorder was neurotic excoriation. The prescription pattern was classified and 51.9% dermatologists are customary with psychotropic agent Doxepin over other agents. The discipline of the multidisciplinary approach was also studied. Limitation: Small sample size, uniregional study, prevalence study. Conclusions: The survey aids in evaluating mental health in cutaneous dermatoses of the elderly and assists the dermatologists to offer understated economical options and amend existing guidelines.

English

BACKGROUND Psoriasis is a chronic skin condition, which can have varied presentation either per se or because of various treatment modalities, which can closely simulate any different dermatological conditions. Hence, a clinicohistopathological correlation is necessary for confirmation of diagnosis and treatment. Very few studies are available in the indexed journals on this subject matter. The present study is aimed to study the clinical and histological features of psoriasiform dermatitis and psoriasis. METHODS This was a longitudinal study consisting of 60 subjects divided into two classes based on clinical diagnosis. Class A patients with diagnosed psoriasis and class B subjects with psoriasiform dermatitis. Many patients have had specific examination and skin biopsy. RESULTS Majority of the cases (40 %) were in the age group of 31 - 40 years. Most common clinical diagnosis was psoriasis (56.7 %) followed by allergic contact dermatitis (13.3 %), pityriasis rosea (8.3 %), lichen simplex chronicus (5 %), seborrheic dermatitis (3 %), Devergie’s disease (3 %), and pityriasis lichenoides chronica (1.6 %). Clinicopathological concordance with psoriasis was seen in 68 cases (68 %) and discordance in 32 cases (32 %). CONCLUSIONS Clinically psoriasis vulgaris can be diagnosed (&gt; 80 %) by presence of micaceous scales, along with grattage test and Auspitz’s sign. But in few, morphological variants of psoriasis and psoriasis modified due to various treatment modalities, we may not see the classical presentation and may mimic various other conditions (psoriasiform dermatitis), in which case a histopathological conformation is essential for diagnosis and treatment. KEYWORDS Psoriasis, Psoriasiform Dermatitis, Auspitz’s Sign, Histopathology

Lichen simplex chronicus positive for C5b-9/MAC, IgD and C3c as a result of recurrent bacterial hair follicular unit infection

Lichen simplex chronicus positive for C5b-9/MAC, IgD and C3c as a result of recurrent bacterial hair follicular unit infection

18888 Prurigo nodularis and lichen simplex chronicus are associated with considerable mental health burden in US inpatients

Background: Prurigo nodularis (PN) and lichen simplex chronicus (LSC) are debilitating pruritic diseases that are associated with psychosocial distress. Little is known about the mental health (MH) comorbidities of PN/LSC. We evaluated the MH comorbidities and emergencies associated with PN/LSC.