Summary
Background. The main cause of lichen simplex chronicus (LSC) is not known but
there is evidence to suggest that neurological abnormalities may be implicated in its
aetiology.
Aim. To investigate neuropathy in patients with LSC on the limbs.
Methods. In total, 23 consecutive patients [15 women (65.2%) and 8 men (34.8%);
mean SD age 48.2 14.03 years, range 2071] with LSC on the limbs were
included in the study. Mean SD duration of disease was 22.86 21.38 months
(range 160). Radiography, magnetic resonance imaging (MRI) and electrophysiological studies were performed for all patients.
Results. In total, 8 patients (34.8%) had LSC on the arms and 15 patients (65.2%)
had LSC on the legs; 3 (37.5%) of the 8 patients with LSC on the arms and 6 (40%) of
the 15 patients with LSC on the legs had radiculopathy in the electrophysiological
studies. The prevalence of radiculopathy in patients with LSC on the limbs was higher
than in asymptomatic subjects in the electrophysiological studies.
Conclusions. Damage to the peripheral nervous system, such as radiculopathy and
neuropathy, can play a critical role in the aetiology of LSC on the limbs. Both nerveroot compression in MRI scans and radiculopathy in nerve-conduction studies are
common findings in asymptomatic subjects, but they seem to be more common in
patients with LSC on the limbs. Therefore, these patients should be evaluated for the
possibility of underlying neuropathy.
Introduction
Lichenification is a pattern of cutaneous response to
repeated rubbing or scratching. It is common in patients
with atopic eczema, but may also be secondary to other
irritant dermatoses. The term lichen simplex chronicus
(LSC) is used for cases where there is no known
predisposing skin disorder, whereas if the excoriation
is initiated by a pruritic dermatosis, the term secondary
lichenification is used.1 LSC, also known as neuroCorrespondence: Dr Ozlem Solak, Afyon Kocatepe Universitesi, Tip Fak,
Fiziksel Tip ve Rehabilitasyon, AD, PK: 03200, Afyon, Turkey.
E-mail: ozlemsolak@hotmail.com
Conflict of interest: none declared.
Accepted for publication 18 January 2008
476
dermatitis circumscripta, is characterized by circumscribed, lichenified, pruritic patches that may develop on
any part of the body.2 The usual sites are the nape of the
neck, the lower legs and ankles, the sides of the neck,
the scalp, the upper thighs, the vulva, pubis or scrotum,
and the extensor forearms.1 Why LSC so often involves
such a limited area and why there are such common
sites of predilection remains unclear.3 In clinical
practice, it has been observed that the patches in LSC
are localized, consistent with the specific innervation to
these regions.
A dermatomal pattern of LSC has been described as
the initial presentation of an intramedullary neoplasm
with syringomyelia.4 In recent studies, an association
between cervical spinal disease and brachioradial
pruritus (BRP), another form of idiopathic localized
Methods
All patients gave informed signed consent, and the
study protocol was approved by our institutional
research ethics committee.
Patients with LSC on the limbs who presented to the
dermatology department between October 2005 and
September 2006 were assessed for the study. All
patients were examined first by a dermatologist.
Patients with localized pruritic, lichenified lesions
located on the limbs with a duration of at least
2 months were clinically diagnosed as having LSC.
Patients with a history of atopic dermatitis, diabetes
mellitus, generalized pruritus and known psychiatric
disorders were excluded from the study groups.
Laboratory tests (complete blood cell count, serum
electrolytes, liver, and kidney function tests) were
performed to disclose any underlying cause of pruritus.
The diagnosis of LSC was made by a dermatologist,
and those patients were enrolled in the study.
All the patients were examined by a rehabilitation
specialist. Cervical radiography and cervical magnetic
resonance imaging (MRI) were performed for all
patients with LSC on the arms. Lumbar radiographs
and lumbar MRI scans were taken for all patients with
LSC on the legs.
Electrophysiological studies were performed in
patients with LSC on the arms, including measurement
of sensory and motor distal latency, conduction velocity
and F waves of the median and ulnar nerves, and
sensory distal latency of the radial nerves of both arms
by a neurologist. For patients with LSC on the legs,
electrophysiological studies including measurement of
sensory and motor distal latency, conduction velocity
and F waves of the peroneal and tibial nerves, and
sensory distal latency of the sural nerves of both legs
were also performed. Needle electromyography (EMG)
studies were performed when there was an abnormality
in physical examination or MRI findings.
Statistical analysis
Results
In total, 23 patients with local pruritus were included in
the study. Of these, 15 patients (65.2%) had LSC on the
legs and 8 (34.8%) had LSC on the arms. There were 15
women (65.2%) and 8 men (34.8%), mean SD age
48.2 14.03 (range 2071).
Mean duration of pruritus was 22.86 21.38
months (range 160). Localized pruritus had been
present in 11 patients (47.8%) h < 12 months and in
12 (52.2%) >12 months. The pruritus was present on
the right side in 10 patients (43.5%), the left side in 5
(21.7%) and on both sides in 8 (69.9%).
Hypoesthesia was found in 3 patients (13.1%),
hyperesthesia in 1 (4.3%), and normal sensation in 19
(82.6%). One patient (4.3%) had muscle weakness.
Deep tendon reflexes were hypoactive in 5 patients
(21.7%) and normoactive in 17 (73.9%) (Table 1).
Cervical and lumbosacral radiographs showed signs
of degenerative changes of the spine in 10 patients
(43.5%) including sclerosis, anterior and posterior
osteophytes, and narrowing of the intervertebral space.
The radiographs were normal in 13 patients (56.5%).
Half (50%) of the patients with LSC on the arms (one
aged < 45 years, two in the age range 4565 years,
and one aged > 65 years) had degenerative changes in
the cervical spine. We found radiographic changes in
40% of the patients with LSC on the legs (five in the age
range 4565 years, one aged > 65 years).
Table 1 Neurological examination results in patients with and
without radiculopathy in electromyography.
Radiculopathy
Positive
(n = 9)
Muscle
Normal
Weakness
Sensation
Normal
Hypoaesthesia
Hyperaesthesia
DTR
Normoactive
Hypoactive
Hyperactive
Negative
(n = 14)
88.9
11.1
8
1
100.0
0.0
14
0
NS
88.9
11.1
0.0
8
1
0
78.6
14.3
7.1
11
2
1
NS
66.7
22.2
11.1
6
2
1
78.6
21.4
0.0
11
3
0
NS
477
Radiography
Normal
Degenerative
MRI
Normal
Disc herniation
Nerve-root compression
Patient
no.
Results of EMG studies
Negative
(n = 14)
33.3
66.7
3
6
71.4
28.6
10
4
NS
0.0
66.7
33.3
0
6
3
50.0
42.9
7.1
7
6
1
NS
Discussion
Nervous system pathology is not often recognized as a
cause of LSC on the limbs. However, we suggest that
radiculopathy can cause this particular feature, because
478
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
Normal
Normal
Radiculopathy
Normal
Normal
Radiculopathy
Normal
Axonal neuropathy
Radiculopathy
Normal
Normal
Radiculopathy
Radiculopathy
Radiculopathy + demyelinating
peripheral neuropathy
Demyelinating peripheral
neuropathy
Normal
Normal
Radiculopathy
Normal
Radiculopathy
Radiculopathy
Normal
Normal
Corresponding Pruritus
disc
dermatome
L5 and S1
S1
L4
C7
C8
L5, S1
C6
L4, L5
L5
L1
C5
S1, S2
C6, C7
L4, L5, S1
L4, L5, S1
C5, C6
L3, L4, L5
C7
C7, C8
L5, S1
L4, L5
C6
L4
L4, L5
L5, S1
C7, C8
C6, C7
L4
L4, L5, S1
L4, L5
S1
L4, L5
EMG, electromyography.
F 50
M 28
F 36
M 53
F 44
F 20
F 36
M 65
)
)
+
)
)
+
)
)
9
10
11
12
13
14
F 29
F 45
M 48
M 58
F 71
M 67
+
)
)
+
+
+
15
M 58
16
17
18
F 32
F 38
F 63
)
)
+
19
20
21
22
23
Total
F 56
F 50
F 55
M 28
F 47
)
+
+
)
)
9 23
(39.1%)
Mild axonal
neuropathy
Demyelinating
peripheral
neuropathy
Demyelinating
peripheral
neuropathy
Carpal tunnel
entrapment in
EMG studies
4 23 (17.4%)
C6
L4, L5
L5
L1
C5
S1, S2
C6, C7
L4, L5, S1
L4, L5, S1
C5, C6
L3, L4, L5
C7
C7, C8
L5, S1
L4, L5
L5, S1
C7, C8
C6, C7
L4
L4, L5, S1
L4, L5
S1
L4, L5
EMG, electromyography.
479
480
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