Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 5151  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
CASE REPORT
Year : 2020  |  Volume : 65  |  Issue : 1  |  Page : 47-49
Lichen simplex chronicus secondary to scald injury and skin flap transplantation


1 Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
2 Department of Patholgoy, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
3 Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China

Date of Web Publication13-Jan-2020

Correspondence Address:
Zhi Qiang Yin
Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu - 210029
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_88_19

Rights and Permissions

   Abstract 


A 50-year-old woman had suffered from chronic pruritic plaque located on right retroauricular area for around 16 years, which was diagnosed as lichen simplex chronicus. Seventeen years ago, patient had multiple scalded areas distributed throughout the body and underwent autologous skin flap transplantation for the right retroauricular wound. After the wound healed, patient started experiencing paresthesia continuously on the skin grafted area and could not resist scratching. To our knowledge, this is the first reported case of lichen simplex chronicus secondary to scald injury and skin flap transplantation. We successfully treated this patient with dyclonine hydrochloride cream 1% and desonide cream 0.05%.


Keywords: Lichen simplex chronicus, neurodermatitis, pruritus, scald, skin transplantation


How to cite this article:
Xu JL, Song GX, Yin ZQ. Lichen simplex chronicus secondary to scald injury and skin flap transplantation. Indian J Dermatol 2020;65:47-9

How to cite this URL:
Xu JL, Song GX, Yin ZQ. Lichen simplex chronicus secondary to scald injury and skin flap transplantation. Indian J Dermatol [serial online] 2020 [cited 2020 Jan 27];65:47-9. Available from: http://www.e-ijd.org/text.asp?2020/65/1/47/275776





   Introduction Top


Lichen simplex chronicus (LSC), also known as neurodermatitis, is a very common chronic pruritic skin disease characterized by distinct skin lichenification due to chronic itching and scratching.[1] The lesions generally occur in normal skin, and the most common sites of onset are the scalp, upper eyelid, neck, retroauricular skin, elbow, and sacrococcygeal region.

Herein, we present a rare encountered case who suffered from LSC secondary to scald injury and skin flap transplantation on the right retroauricular skin.


   Case Report Top


A 50-year-old woman presented to our department with chronic pruritic plaque located on right retroauricular area for around 16 years [Figure 1]. Seventeen years ago, patient had multiple scalded areas distributed throughout the body and underwent autologous skin flap transplantation for the right retroauricular wound. After the wound healed, patient started experiencing paresthesia that was a complex feeling including itching and other inenarrable symptoms as per the patient's description, which continuously existed on the skin grafted area and the patient could not resist scratching. Over the years, patient visited several hospitals and was prescribed various medications including topical corticosteroids. Later on, the rash disappeared; however, the paresthesia still persisted with frequent temptation to scratch. Other scalded areas that did not undergo skin flap transplantation healed autogenously without any obvious discomfort. The skin flap was obtained from the extensor aspect of the patient's right thigh. The patient had no history of allergic and psychogenic diseases and the family history was unremarkable.
Figure 1: Right retroauricular skin. Irregular red plaque with significant lichenification arising on the right retroauricular skin, some fissure and minute scales on the surface of the plaque

Click here to view


Clinical examination revealed an irregular red plaque with significant lichenification, minimal scaling, and fissuring localized on the right retroauricular skin [Figure 1]. On the extensor aspect of the right thigh, an irregular depigmented macule with mild epidermal atrophy can be seen [Figure 2].
Figure 2: Right thigh skin. Irregular depigmentation macule with mild epidermal atrophy on the extensor aspect of right thigh

Click here to view


No superficial lymphadenopathy was noted. Blood routine examination, hepatic, and renal functions were noted to be within normal range. Chest radiograph and B-mode ultrasonography did not reveal any obvious abnormality.

This patient was diagnosed as LSC, and to our knowledge, this is the first reported case of lichen simplex chronicus secondary to scald injury and skin flap transplantation. The patient gave written informed consent according to the Declaration of Helsinki and the record of patient was anonymized and de-identified.


   Discussion Top


Various factors, including local stimulation and psychological factors, are related to the development of LSC. Psychological factors, such as anxiety, depression, and sleep disturbances, were found to contribute to both the development and persistence of LSC.[1],[2] On the other hand, LSC moderately affects the patient's quality of life, by causing a certain degree of psychosocial burden, sleep disturbance, and even sexual dysfunction.[3] In this case, the woman had no prior history of any psychogenic disease and did not suffer from LSC or other dermatitis before scald injury and skin grafting. The important chief complaint was local paresthesia in the grafted area.

Pruritus is a common and severe problem among burn patients, and higher intensity of itching is thought to be associated with depth of the wounds and specific body locations.[4],[5] Kuipers et al.[5] studied 226 patients with burn and followed them for 18 months and found that there was no difference in the overall itch intensity between the grafted patients and the nongrafted patients. Choinière et al.[6] investigated 104 burn patients during a 7-year period and found that 82% reported paresthetic sensations such as tingling, stiffness, cold sensations, and numbness; and the prevalence of these sensations was associated with the burn size and skin grafting.

This patient had previously been hospitalized for multiple areas of scalding but not burn injury. According to the patient's description, her situation was not that severe but the surgeon worried about the indolence of right retroauricular wound, treated her with skin flap transplantation. However, she experienced paresthetic sensations in the grafted area and had no discomfort in the nongrafted areas. We presume that the cause of paresthesia might be related to probable deeper wound on the right retroauricular skin, specific body location, improper reinnervation of the autograft, or the injury of cutaneous sensory nerve during skin grafting procedure. Because of persistent paresthesia and uncontrollable scratching, LSC had tormented this woman for 16 years.

Based on the specific condition of this patient, desonide cream 0.05% was prescribed for treating skin inflammation and dyclonine hydrochloride cream 1% for controlling local paresthesia. Desonide 0.05% is a safe and effective low-potency corticosteroid for the treatment of mild-to-moderate dermatoses, including atopic dermatitis, seborrheic dermatitis, eczema, lichen simplex chronicus, and so on.[7],[8],[9] Dyclonine hydrochloride 1% is a commonly used topical anesthetic that could alleviate the pain, itch, or paresthesia. In this case, desonide was applied on the lesion first, after 30 minutes, dyclonine hydrochloride was applied, twice a day. After 2 weeks, the patient did not come back for return visit due to busy work and then was followed up by phone. She gave feedback that the rash and paresthesia had almost disappeared and scratching was no longer out-of-control.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Juan CK, Chen HJ, Shen JL, Kao CH. Lichen simplex chronicus associated with erectile dysfunction: A population-based retrospective cohort study. PLoS One 2015;10:e0128869.  Back to cited text no. 1
    
2.
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;170:890-4.  Back to cited text no. 2
    
3.
An JG, Liu YT, Xiao SX, Wang JM, Geng SM, Dong YY. Quality of life of patients with neurodermatitis. Int J Med Sci 2013;10:593-8.  Back to cited text no. 3
    
4.
Gauffin E, Öster C, Gerdin B, Ekselius L. Prevalence and prediction of prolonged pruritus after severe burns. J Burn Care Res 2015;36:405-13.  Back to cited text no. 4
    
5.
Kuipers HC, Bremer M, Braem L, Goemanne AS, Middelkoop E, van Loey NE. Itch in burn areas after skin transplantation: Patient characteristics, influencing factors and therapy. Acta Derm Venereol 2015;95:451-6.  Back to cited text no. 5
    
6.
Choinière M, Melzack R, Papillon J. Pain and paresthesia in patients with healed burns: An exploratory study. J Pain Symptom Manage 1991;6:437-44.  Back to cited text no. 6
    
7.
Bhankharia DA, Sanjana PH. Efficacy of desonide 0.05% cream and lotion in steroid-responsive dermatoses in Indian patients: A post-marketing surveillance study. Indian J Dermatol Venereol Leprol 2004;70:288-91.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Trookman NS, Rizer RL. Randomized controlled trial of desonide hydrogel 0.05% versus desonide ointment 0.05% in the treatment of mild-to-moderate atopic dermatitis. J Clin Aesthet Dermatol 2011;4:34-8.  Back to cited text no. 8
    
9.
Elewski B. An investigator-blind, randomized, 4-week, parallel-group, multicenter pilot study to compare the safety and efficacy of a nonsteroidal cream (Promiseb Topical Cream) and desonide cream 0.05% in the twice-daily treatment of mild to moderate seborrheic dermatitis of the face. Clin Dermatol 2009;27(6 Suppl):S48-53.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (877 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
   Case Report
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed91    
    Printed0    
    Emailed0    
    PDF Downloaded5    
    Comments [Add]    

Recommend this journal