A Retrospective Analysis of Itch Intensity and Comorbidities in Lichen Simplex Chronicus
DOI:
https://doi.org/10.2340/actadv.v105.43776Keywords:
Chronic pruritus, comorbidities, itch intensity, itch localization, lichen simplex chronicus, multidisciplinary managementAbstract
Lichen simplex chronicus is a chronic pruritic skin condition that significantly impacts quality of life. This retrospective study analysed 125 patients with clinically confirmed lichen simplex chronicus seen at a tertiary academic centre to characterize itch severity, anatomical distribution, and associated comorbidities. Itch intensity was assessed using the Numerical Rating Scale (NRS), and clinical data were stratified by demographics and disease extent. Most patients (75%) reported moderate-to-severe itch (NRS 4–10), with nearly 90% experiencing daily pruritus and half reporting both daytime and nocturnal symptoms. The limbs were the most commonly affected sites. Comorbid conditions were frequent, including generalized anxiety disorder (50% vs ~3% in the US adult population), major depressive disorder (44% vs ~8%), hypertension (61% vs ~45%), and type 2 diabetes (30% vs ~11%). Patients with multiple-lesion lichen simplex chronicus had significantly higher itch severity (mean NRS 7.81 vs 7.08, p = 0.001) and were more likely to be female (81% vs 46%, p = 0.002) compared with those with localized disease. These findings highlight the high symptom burden and frequent co-occurrence of psychiatric and metabolic comorbidities in lichen simplex chronicus. Thus, early identification and management of psychiatric, neurological, and metabolic conditions may improve outcomes for patients with lichen simplex chronicus.
Downloads
References
Farage MA, Miller KW, Berardesca E, Maibach HI. Clinical implications of aging skin: cutaneous disorders in the elderly. Am J Clin Dermatol 2009; 10: 73–86. DOI: https://doi.org/10.2165/00128071-200910020-00001
Tianco EA, Buendia-Teodosio G, Alberto NL. Survey of skin lesions in the Filipino elderly. Int J Dermatol 1992; 31: 196–198. DOI: https://doi.org/10.1111/j.1365-4362.1992.tb03935.x
Valdes-Rodriguez R, Stull C, Yosipovitch G. Chronic pruritus in the elderly: pathophysiology, diagnosis and management. Drugs Aging 2015; 32: 201–215. DOI: https://doi.org/10.1007/s40266-015-0246-0
Konuk N, Koca R, Atik L, Muhtar S, Atasoy N, Bostanci B. Psychopathology, depression and dissociative experiences in patients with lichen simplex chronicus. Gen Hosp Psychiatry 2007; 29: 232–235. DOI: https://doi.org/10.1016/j.genhosppsych.2007.01.006
Yosipovitch G, Bernhard JD. Clinical practice: chronic pruritus. N Engl J Med 2013; 368: 1625–1634. DOI: https://doi.org/10.1056/NEJMcp1208814
Roh YS, Choi J, Sutaria N, Kwatra SG. Itch: epidemiology, clinical presentation, and diagnostic workup. J Am Acad Dermatol 2022; 86: 1–14. DOI: https://doi.org/10.1016/j.jaad.2021.07.076
Mack MR, Kim BS. The itch–scratch cycle: a neuroimmune perspective. Trends Immunol 2018; 39: 980–991. DOI: https://doi.org/10.1016/j.it.2018.10.001
Ferreira BR, Aguirre CC, Rapoport-Hubschman N, Adewuya AO, Canchy L, Morizet D, et al. The skin–brain connection and pleasant touch as supportive care for psychocutaneous disorders. Skin Health Dis 2024; 4: e310. DOI: https://doi.org/10.1002/ski2.310
Altunay IK, Ozkur E, Ugurer E, Baltan E, Aydin C, Serin E. More than a skin disease: stress, depression, anxiety levels, and serum neurotrophins in lichen simplex chronicus. An Bras Dermatol 2021; 96: 700–705. DOI: https://doi.org/10.1016/j.abd.2021.04.011
Ju T, Vander Does A, Mohsin N, Yosipovitch G. Lichen simplex chronicus itch: an update. Acta Derm Venereol 2022; 102: adv00796. DOI: https://doi.org/10.2340/actadv.v102.4367
Rajalakshmi R, Thappa DM, Jaisankar TJ, Nath AK. Lichen simplex chronicus of anogenital region: a clinico-etiological study. Indian J Dermatol Venereol Leprol 2011; 77: 28–36. DOI: https://doi.org/10.4103/0378-6323.74970
Engin B, Tufekci O, Yazici A, Ozdemir M. The effect of transcutaneous electrical nerve stimulation in the treatment of lichen simplex: a prospective study. Clin Exp Dermatol 2009; 34: 324–328. DOI: https://doi.org/10.1111/j.1365-2230.2008.03086.x
Visconti MJ, Haidari W, Feldman SR. Transcutaneous electrical nerve stimulation (TENS): a review of applications in dermatology. J Dermatolog Treat 2020; 31: 846–849. DOI: https://doi.org/10.1080/09546634.2019.1657227
Goldstein AT, Parneix-Spake A, McCormick CL, Burrows LJ. Pimecrolimus cream 1% for treatment of vulvar lichen simplex chronicus: an open-label, preliminary trial. Gynecol Obstet Invest 2007; 64: 180–186. DOI: https://doi.org/10.1159/000106487
Yosipovitch G, Sugeng MW, Chan YH, Goon A, Ngim S, Goh CL. The effect of topically applied aspirin on localized circumscribed neurodermatitis. J Am Acad Dermatol 2001; 45: 910–913. DOI: https://doi.org/10.1067/mjd.2001.117399
Charifa A, Badri T, Harris BW. Lichen simplex chronicus. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Talel Badri declares no relevant financial relationships with ineligible companies. Disclosure: Blair Harris declares no relevant financial relationships with ineligible companies; 2024.
Singh N, Thappa DM, Jaisankar TJ, Habeebullah S. Pattern of non-venereal dermatoses of female external genitalia in South India. Dermatol Online J 2008; 14: 1. DOI: https://doi.org/10.5070/D35HS3F52V
O’Keefe RJ, Scurry JP, Dennerstein G, Sfameni S, Brenan J. Audit of 114 non-neoplastic vulvar biopsies. Br J Obstet Gynaecol 1995; 102: 780–786. DOI: https://doi.org/10.1111/j.1471-0528.1995.tb10842.x
Valdes-Rodriguez R, Mollanazar NK, Gonzalez-Muro J, Nattkemper L, Torres-Alvarez B, Lopez-Esqueda FJ, et al. Itch prevalence and characteristics in a Hispanic geriatric population: a comprehensive study using a standardized itch questionnaire. Acta Derm Venereol 2015; 95: 417–421. DOI: https://doi.org/10.2340/00015555-1968
Lavery MJ, Stull C, Kinney MO, Yosipovitch G. Nocturnal pruritus: the battle for a peaceful night’s sleep. Int J Mol Sci 2016; 17: 425. DOI: https://doi.org/10.3390/ijms17030425
Schmid Y, Navarini A, Thomas ZM, Pfleiderer B, Krahenbuhl S, Mueller SM. Sex differences in the pharmacology of itch therapies – a narrative review. Curr Opin Pharmacol 2019; 46: 122–142. DOI: https://doi.org/10.1016/j.coph.2019.05.008
Thornton MJ. Estrogens and aging skin. Dermatoendocrinol 2013; 5: 264–270. DOI: https://doi.org/10.4161/derm.23872
Rimoin LP, Kwatra SG, Yosipovitch G. Female-specific pruritus from childhood to postmenopause: clinical features, hormonal factors, and treatment considerations. Dermatol Ther 2013; 26: 157–167. DOI: https://doi.org/10.1111/dth.12034
Chey WY, Kim KL, Yoo TY, Lee AY. Allergic contact dermatitis from hair dye and development of lichen simplex chronicus. Contact Dermatitis 2004; 51: 5–8. DOI: https://doi.org/10.1111/j.0105-1873.2004.00252.x
Golpanian RS, Fourzali K, Fowler E, Kursewicz CD, Lipman Z, Chan YH, et al. The pleasurability of scratching an itch amongst different pruritic conditions. Acta Derm Venereol 2020; 100: adv00254. DOI: https://doi.org/10.2340/00015555-3605
Bin Saif GA, Papoiu AD, Banari L, McGlone F, Kwatra SG, Chan YH, et al. The pleasurability of scratching an itch: a psychophysical and topographical assessment. Br J Dermatol 2012; 166: 981–985. DOI: https://doi.org/10.1111/j.1365-2133.2012.10826.x
Barros G, Duran P, Vera I, Bermudez V. Exploring the links between obesity and psoriasis: a comprehensive review. Int J Mol Sci 2022; 23: 7499. DOI: https://doi.org/10.3390/ijms23147499
Paroutoglou K, Papadavid E, Christodoulatos GS, Dalamaga M. Deciphering the association between psoriasis and obesity: current evidence and treatment considerations. Curr Obes Rep 2020; 9: 165–178. DOI: https://doi.org/10.1007/s13679-020-00380-3
Korman NJ. Management of psoriasis as a systemic disease: what is the evidence? Br J Dermatol 2020; 182: 840–848. DOI: https://doi.org/10.1111/bjd.18245
Huang AH, Canner JK, Khanna R, Kang S, Kwatra SG. Real-world prevalence of prurigo nodularis and burden of associated diseases. J Invest Dermatol 2020; 140: 480–483 e484. DOI: https://doi.org/10.1016/j.jid.2019.07.697
Olbrich H, Kridin K, Hernandez G, Zirpel H, Sadik CD, Terheyden P, et al. Increased cardiovascular risks and mortality in prurigo nodularis: a global cohort study. EBioMedicine 2024; 103: 105123. DOI: https://doi.org/10.1016/j.ebiom.2024.105123
Ostchega Y, Fryar CD, Nwankwo T, Nguyen DT. Hypertension prevalence among adults aged 18 and over. NCHS Data Brief. Hyattsville, MD: National Center for Health Statistics, 2020.
National Diabetes Statistics Report. Atlanta, GA: U.S. Centers for Disease Control and Prevention, 2024.
Generalized Anxiety Disorder. Bethesda, MD: National Institute of Mental Health, 2023.
Major Depression. Bethesda, MD: National Institute of Mental Health, 2023.
Liao YH, Lin CC, Tsai PP, Shen WC, Sung FC, Kao CH. Increased risk of lichen simplex chronicus in people with anxiety disorder: a nationwide population-based retrospective cohort study. Br J Dermatol 2014; 170: 890–894. DOI: https://doi.org/10.1111/bjd.12811
Martín-Brufau R, Corbalan-Berna J, Ramirez-Andreo A, Brufau-Redondo C, Liminana-Gras R. Personality differences between patients with lichen simplex chronicus and normal population: a study of pruritus. Eur J Dermatol 2010; 20: 359–363. DOI: https://doi.org/10.1684/ejd.2010.0961
Cohen AD, Andrews ID, Medvedovsky E, Peleg R, Vardy DA. Similarities between neuropathic pruritus sites and lichen simplex chronicus sites. Isr Med Assoc J 2014; 16: 88–90.
Sandoval M, Parra J, Reyna-Jeldes M, Curi-Tuma M, Espinoza F, Munoz D, et al. Itch in lichen simplex chronicus is associated with localized small fiber neuropathy. J Invest Dermatol 2022; 142: 731–735 e733. DOI: https://doi.org/10.1016/j.jid.2021.08.429
Chung BY, Um JY, Kim JC, Kang SY, Park CW, Kim HO. Pathophysiology and treatment of pruritus in elderly. Int J Mol Sci 2020; 22. DOI: https://doi.org/10.3390/ijms22010174
Biazus Soares G, Mahmoud O, Yosipovitch G, Mochizuki H. The mind–skin connection: a narrative review exploring the link between inflammatory skin diseases and psychological stress. J Eur Acad Dermatol Venereol 2024; 38: 821–834. DOI: https://doi.org/10.1111/jdv.19813
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Kayla D. Mashoudy, Joselyn Ye-Tay, Sarah Kim, Nicole Khalil, Gil Yosipovitch
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
