Lichen Simplex Chronicus or Neurodermatitis as it is commonly known is an intensely pruritic rash, sharply localized to one or a few sites, characterized by thickening and exaggeration of the skin surface markings.

It is commonly found in middle aged subjects of both sex and all races. It has also been found more commonly in Indian subcontinent

Clinical Features:

It presents with extreme and persistent itching.

Lesions are

• characteristically raised,
• Irregular, flat papules,
• Usually of skin or brown color.
• Single or coalescing to form a single patch
• With well defined margins and
• Prominent skin markings (lichenification).

Sites frequently involved are nape of neck in women, legs in men and anogenital area in both. Medial aspect of ankle, extensor aspects of forearms, the wrists are other common sites involved.

Types

Prurigo nodule: If the itching is persistent, intense and the resultant scratching vigorous, the affected site becomes very thickened, raised and excoriated. The lesion is then known as prurigo nodule.

Prurigo nodularis: When many such nodules occur over the surface, the condition is known as prurigo nodularis.

Complication:

Repeated scratching often results in secondary infection.

Prognosis:

LSC has been known as a very stubborn and persistent disorder, which may stay unchanged for years. Sometimes the lesions reappear after treatment is stopped.

Investigations:

Biopsy may be needed to distinguish it with Psoriasis and hypertrophic lichen planus. The epidermal hypertrophy in LSC helps it to distinguish from others.

Management:

Patient should be advised to avoid damaging the skin by repeated scratching.

Homeopathic Approach

Homeopathic medicines have been found effective in relieving the extreme itching of Neurodermatitis but unless and until the fundamental cause of the disease i.e. Miasm is dealt with cure cannot be established.

Also it is important not to stop the treatment too early even after clinical cure because the lesions may reappear.

Miasm: Lichen simplex chronicus is predominantly a Psoro-sycotic disease.

The early stages of disease when itching is predominant have Psora predominant but in late stages of disease when lesions become lichenified and hyperpigmented there is also an involvement of Sycosis. So depending on the stage of disease there is requirement of antimiasmatic remedy to effectively establish cure.

Research on Lichen simplex chronicus:

Research by Dr. Ramji Gupta, Dr. R.K.Manchanda and Dr. B.S. Arya (Department of Dermatology, Nehru Homoeopathic Medical College and Hospital, New Delhi, India) on 27 patients suffering from Lichen simplex chronicus involving various parts of the body showed the utility of Homeopathic medicines in such cases. Following remedies were used in the cases: Hydrocotyle was prescribed to 21 patients in different potencies (6c, 30c, 200c, 1 M, 10 M), Thuja to three patients (1 M, 10 M), Graphites (6c), Kali bich (30c) and Sulphur (200c) to one patient each during 1 year study period.

It was found that only two patients showed complete improvement with Thuja and one with Graphites. In other cases, the response was limited to partial relief of itching.

Homeopathic Therapeutics:

Hydrocotyle: Has found to be effective in great thickening of epidermoid layer. Intolerable itching, especially on soles. Profuse perspiration.

Graphitis: Rough, hard, persistent dryness of portions of skin unaffected by eczema. Patient chilly, constipated with tendency to skin affections.

Thuja-occ: Dry skin, with brown spots. Eruptions only on covered parts, worse after scratching. Very sensitive to touch.

Sulphur: Dry, scaly, unhealthy skin with itching and burning, worse scratching and washing. Pruritus, especially from warmth in evening, often recurs in spring time, in damp weather. Dry and hard hair and skin.

Rhus-tox: Skin red, swollen with intense itching. Rhus-tox and Thuja have been found effective in high potency in cases of Lichen simplex chronicus.

Alumina: Skin chapped and dry; intolerable itching when getting warm in bed. Must scratch until it bleeds then becomes painful.

Sepia: Itching not relieved by scratching; worse in bends of elbows and knees. Profuse sweat with foul odor worse on toes.

References:

• Homoeopathy for the treatment of lichen simplex chronicus: a case series. Homeopathy Journal, 2006 Oct;95(4):245-7.
• Khanna, Neena, Illustrated Synopsis of Dermatology and Sexually Transmitted Diseases, Third Edition, Elsevier.
• Marks, Ronald, Roxburgh's Common Skin Diseases, !7 th Edition, Arnold Publishers, London, 2003
• Gupta Ramji and Manchanda R.K., Textbook of Dermatology for Homoeopaths; B.Jain Publishers (P.) Ltd.