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International Journal of Medical and Health Sciences

Journal Home Page: http://www.ijmhs.net ISSN:2277-4505

Case Report
A Case of Neurodermitis Circumscripta with Generalized Pruritis
Hari Babu Ramineni1*, Manogna A S K L2,Chandini M3, Vidyadhara S4
1

Professor, 2,3 Post Graduate Students,4 Professor, Department of Clinical Pharmacy,


Chebrolu Hanumaiah Institute of Pharmaceutical Sciences, Chowdavaram, Guntur, Andhra Pradesh, India.522019.

ABSTRACT
Neurodermitis Circumscripta also known as Lichen Simplex Chronicusis a chronic inflammation of the skin characterized by
lichenification of the skin as a result of excessive scratching. We hereby report this in a 70 year old female who presented with
complaints of itching all over the body and lesions on the skin of right leg since two months. She is a known case of bronchial
asthma and hypertension. After proper history taking and investigations she was diagnosed as Neurodermitis Circumscripta with
generalized Pruritus. She was treated with intralesional steroids, oral Doxepin and antibiotics. Complete remission of symptoms
occurred in 3 months.
KEYWORDS: Pruritus, Intralesional Steroids, Dermatitis, Lesions, Lichenification.
INTRODUCTION
Neurodermatitis Circumscripta also commonly called as
Lichen Simplex Chronicus(LSC) is a chronic skin disease
characterized by small, round itchy spots that thicken and
become leathery, which occur as result of constant
scratching or rubbing of skin[1]. Itching is the most
predominant symptom and provokes a compulsive desire to
scratch results in development of lichenified plaques which
provoke further itching, giving rise to a chronic skin
condition caused by this itching-scratching cycle[2].
Common sites are nape of neck, ankles, anogenital region
and scalp. Effective management of skin conditions involves
correction of the associated emotional factors[3].
CASE REPORT
The present case report is about a 70-year-old female patient
with low socioeconomic status who presented to
dermatology out-patient department with itching all over the
body and lesions on the skin of right leg since two months.

Int J Med Health Sci. Jan 2015,Vol-4;Issue-1

She is a known case of bronchial asthma and hypertension.


There was no history of any local applications or any drug
intake. On examination, she was hyperpigmented, itching all
over the body since 3 months and scaly plaques were found
all over the skin and lateral aspects of right leg (figure 1).
Routine blood and urine investigations, blood sugar, liver,
renal and thyroid functions were normal.
Skin biopsy revealed hyperkeratosis, hypergranulosis,
acanthosis, and thickening of collagen in dermis suggesting
Neurodermitis Circumscripta with generalized Pruritus.
Patient was given intralesional injection of Triamcinolone
acetonide 2.5 mg/ml weekly for 4 weeks along with
Doxepin hydrochloride 10 mg, Levocitrizine 5mg at night
and Augmentin 625mg TID for one week. There was
marked reduction in itching in the 1st week and complete
regrowth of normal skin at end of 4 weeks. Doxepin was
stopped after 3 months. Patient came for follow-up monthly
thereafter for 6 months with no remission.

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Figure: 1 Scaly plaque on leg

Figure: 2 The biopsy of the skin indicated hyperkeratosis,


hypergranulosis, acanthosis was observed (hematoxylin &
eosin staining, original magnification 100).

DISCUSSION
Neurodermatitis Circumscripta is thickening of the skin with
variable scaling that arises secondary to repetitive scratching
or rubbing. Neurodermitis Circumscriptais not a primary
process. Rather, a person senses pruritus in a specific area of
skin and causes mechanical trauma to the point of
lichenification [4]. The peak incidence of Neurodermitis
Circumscripta is between 35 and 50 years of age and the
condition is more common in women, with a female-to-male
ratio of 2:1. It can present in either gender and at any age,
including during childhood, when it more commonly occurs
in boys[5]. It occurs in people with anxiety disorders and
nonspecific emotional stress as well as in patients with any
type of chronic dermatitis[6].
Itch scratch cycle is paroxysmal and patient scratches until it
pains or bleeding occurs. This self-perpetuating mechanism
is the main pathogenesis of Neurodermitis Circumscripta[7].
Insect bites, scars (eg, traumatic, postherpetic/zoster), acne
keloidalisnuchae, xerosis, venous insufficiency, and
asteatotic eczema are common factors[8]. Etiology of
Neurodermatitis Circumscripta results in single or multiple,
slightly
erythematous,
scaly,
well
demarcated,
hyperpigmented, lichenified, rough plaques, on any location
that the patient can reach including the nape of the neck,
extensor forearms and elbows, vulva or scrotum, upper
medial thighs, knees, lower legs, and ankles[9]. Routine
laboratory studies are of no diagnostic value. Diagnostic
tests such as skin biopsy, patch testing, fungal culture, skin
scrapings. Topical treatment modalities for Neurodermitis
Circumscripta with varying success are potent topical
steroids, intralesional steroids[10], keratolytic agents such as
Salicylic acid, Capsacin, Tacrolimus, Pimecrolimus and
Cryotherapy. Systemic modalities of treatment include
sedatives, antihistamines, tricyclic antidepressants and
psychotherapy.
Transcutaneous electric nerve stimulation has been reported
to be effective in reducing itch[11]. The patient in the case
study provides many of the classic characteristics as
Neurodermitis Circumscripta such as itching all over the
body and lesions on the skin of the right leg. The goal of

Int J Med Health Sci. Jan 2015,Vol-4;Issue-1

treatment is to stop the itch-scratch-itch cycle and allow the


skin to heal. Topical steroids like Halobetasolor Clobetasol
0.05% ointment, for two weeks, are the current treatment of
choice as they decrease inflammation and itch while
concurrently softening the hyperkeratosis[12]. If the patient
is not responding to topical therapy then Oral steroids like
Prednisone 40 mg PO for 5days, then 20 mg PO for 10 days
can be given. IM Triamcinolone 1 mg/kg (up to 80 mg total)
can be used instead of Prednisone for severe, itchy or
extensive Neurodermitis Circumscripta. If it is an infection
then antibiotics like Cefadroxil 500 mg for 7 days,
Fluconazole 150 mg PO for 2 weeks. Sedatives like
Doxepin or Hydroxyzine 10 to 75 mg for night time itching
[13].
CONCLUSION
Neurodermitis Circumscripta is a chronic inflammatory skin
disease characterized by paroxysms of pruritus and the
development of lichenoid changes of the skin. The disease
occurs from repeated scratching or rubbing, either as a habit
or in response to stress. There is no underlying
dermatological disorder. Internal treatment is the main
treatment for the disseminated type of Neurodermitis
Circumscripta, where as external treatment is suggested for
the localized type. This case is reported for the importance
of differential diagnosis in cases of pruritis with dermatitis
in individuals with emotional factors such as emotional
depression, nervous tension, irritability, and stress.
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_______________________________________________
*Corresponding author: HariBabu Ramineni
E-Mail: haris760@gmail.com

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