Comparative Study of Quality of Life and Obsessive-Compulsive Tendencies in Patients With Chronic Hand Eczema and Lichen Simplex Chronicus.

BACKGROUND: Lichen simplex chronicus (LSC) and chronic hand eczema (CHE) are 2 common dermatological disorders that affect physical, social, and psychological aspects of life. The aim of this study was to compare quality of life and obsessive-compulsive tendencies between patients with LSC and patients with CHE. MATERIALS AND METHODS: Sixty patients with LSC, 60 patients with CHE, and 60 healthy controls were included in the study. Quality of life was evaluated according to the Dermatology Life Quality Index (DLQI). Patients were also assessed for compulsive behavior with the Leyton Trait Scale. RESULTS: Patients with LSC (13.00 [1.41]) had a statistically significant higher mean (SD) DLQI compared with patients with CHE (11.33 [1.53]). Patients with LSC (13.97 [2.14]) presented statistically significant higher levels of obsessive-compulsive personality traits than patients with CHE (12.48 [2.69]), whereas both groups also differed from the healthy controls (10.68 [3.87]). The DLQI was not correlated with the Leyton Trait Scale in either the patients with LSC (r = 0.10, P = 0.50, not significant [NS]) or in the CHE patients (r = 0.01, P = 0.92, NS). CONCLUSIONS: Although both LSC and CHE are associated with impaired quality of life and obsessive-compulsive tendencies, significantly higher scores were recorded in patients with LSC.

[Vulvar pruritus: determination of the most common causes and their treatments]. / Prurito vulvar: determinación de las causas más frecuentes y su tratamiento.

Vulvar pruritus can be caused by a wide spectrum of diseases, that depend on age, environmental and genetic factors. The most common causes are candidiasis, contact dermatitis and lichen simplex chronicus. Candidiasis is the most common cause of acute vulvar pruritus and is characterized by burning, itching and vaginal whitish secretion. Contact dermatitis is caused by irritants or allergens that are in contact with the genital area, which causes imbalance in the skin barrier causing irritation, swelling, burning, among other manifestations. Lichen simplex chronicus is characterized by lichenification (thickening of the skin) secondary to the chronic itch-scratch cycle in vulvar area. It is an illnes with a tendency to chronicity, but with topical corticosteroids treatment usually might be controlled. Prompt treatment, multidisciplinary and careful attention to irritants and secondary infections prevent these entities become an important and permanent problem.

Similarities between neuropathic pruritus sites and lichen simplex chronicus sites.

BACKGROUND: Localized itch of non-pruritoceptive origin is often neuropathic and may be referred to as neuropathic itch syndrome. OBJECTIVES: To describe the results of nerve conduction studies in patients with anogenital pruritus, brachioradial pruritus and scalp dysesthesia, and compare these sites to typical sites of lichen simplex chronicus (LSC). METHODS: The study summarizes previously published data combined with unpublished data of patients with scalp dysesthesia. Nerve conduction studies included measurements of distal sensory and motor latency, conduction velocity and F-responses. RESULTS: A neuropathy was demonstrated in 29 of 36 patients with anogenital pruritus (80.5%), 8/14 with brachioradial pruritus (57.1%) and 4/9 with scalp dysesthesia (44.4%). The typical sites overlapped with some but not all LSC sites. CONCLUSIONS: A considerable proportion of patients with brachioradial pruritus, anogenital pruritus and scalp dysesthesia have abnormal nerve conduction findings, suggesting a neuropathic origin. The skin sites overlap with some common LSC sites, suggesting that in some cases of LSC a local neuropathy could be a possible cause.

Lichen simplex chronicus as a symptom of neuropathy.

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 20-71] with LSC on the limbs were included in the study. Mean +/- SD duration of disease was 22.86 +/- 21.38 months (range 1-60). 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 nerve-root 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.

Effects of Medical Resonance Therapy Music on patients with psoriasis and neurodermatitis--a pilot study.

Stress medicine has shown that emotional disharmony can be a substantial factor for skin diseases. The harmonisation of the emotional status and a corresponding reduction of stress hormones by the Medical Resonance Therapy Music (MRT-Music) as shown in other studies (1,2,3,4) inspired us to investigate its benefits for patients with psoriasis vulgaris and neurodermatitis (neurodermatitis constitutionalis atopica). Over a period of 14 days we measured the parameters of blood pressure, heart rate, stimulus to scratch and the degree of sickness in two, respectively four groups of 68 patients in total: two experimental groups (psoriasis/neurodermatitis) and two control groups. All patients received the normal treatment of our hospital, the experimental groups were additionally treated with 3 x 30 minutes of MRT-Music per day, while the controls were asked to somehow relax during this time. In the experimental groups the measurements showed a reduction of blood pressure and heart rate and revealed an enhanced reduction of the stimulus to scratch and an enhanced reduction in the degree of sickness. Interestingly the effects of MRT-Music were stronger with the psoriasis patients than with the neurodermatitis patients. The results of this pilot study convinced us to offer the treatment with the Medical Resonance Therapy Music to all our patients.

[The functional activity of the minor salivary glands of the lips in allergic cheilitis]. / Funktsional'naia aktivnost' malykh sliunnykh zhelez gub pri allergicheskom kheilite.

Functional activity of minor salivary glands is studied in 289 children, 52 of these without signs of cheilitis and 237 with allergic cheilitis at different stages. Three variants of secretion are distinguished: fast, medium, and slow. The ratio of these variants changed in exacerbation of disease in comparison with that in health or remission. The activity of the glands depends on clinical manifestations of cheilitis. Changes in the activity of minor salivary glands determine the clinical picture, localization, and type of involvement in cheilitis.

[Psychophysiologic and psychoneuroimmunologic studies in neurodermatitis. Overview and critical evaluation]. / Psychophysiologische und psychoneuroimmunologische Ergebnisse zur Neurodermitis. Ubersicht und kritische Bilanz.

Results of psychophysiological, psychoendocrinological, and psychoneuroimmunological research on the skin in patients with atopic dermatitis were evaluated. 11 investigations were selected and analysed with respect to both design and results. In 6 instances, healthy or ill control groups were included, rarely did the sample size exceed 30. With respect to physiology, blood pressure, heart rate and EDA were most commonly assessed; with respect to immunology, number of leucocytes and differential blood count and with respect to psychology, anxiety, neuroticism and stress perception. The results involving stress induction, itching induction and the relationship of personality and skin parameters were not consistent. The best established relationship is that between skin reactivity (flare, wheal size and pruritus) on the one hand and cognitive appraisal of stress-stimuli and the experimental situation on the other hand. Psychoendocrinological and even more psychoimmunological indicators of the stress of reaction-unlike psychophysiological indicators-were correlated with the skin response. Only half of the studies found an elevated physiological stress reaction in patients with atopic dermatitis.

Lichen simplex chronicus.

A review of the literature for the last 20 years shows no monumental advances in the diagnosis or treatment of the disease; however, there have been some very intriguing insights into the causes. The physical and emotional aspect of the skin condition is well known but the genetic, vascular, and neurogenic implications are of interest.

[Thalidomide treatment of prurigo nodularis]. / Thalidomidbehandling af prurigo nodularis.

Twenty-two patients suffering from prurigo nodularis were treated with thalidomide 50-300 mg daily for an average of 12 months (two weeks to five years), following a special arrangement between the Danish Government and the producer Grünenthal GMBH, by which the Government took full economical responsibility for any claims related to the treatment. All patients received prior to treatment a detailed written information about all potential side-effects from the treatment, and had by their signature acknowledged, that they wished to be treated. All but two of the patients had an immediate pronounced effect on their main symptom, the tormenting itching. The same patients had a significant decrease in size and numbers of skin lesions after one to two months of treatment. However, the therapy had to be discontinued in thirteen patients (59%) due to side-effects. The most important side-effect, neuropathy, was the reason for discontinuation of thalidomide in five patients (22%). In spite of the high frequency of side-effects, we consider that this treatment modality should still be offered to the patients with the most severe symptoms due to the pronounced effect on this otherwise therapy resistant disease.

Lichen simplex chronicus as the initial manifestation of intramedullary neoplasm and syringomyelia.

Neurogenic causes of pruritus and a rash are uncommon. We report a patient with dermatomal pruritus and a rash who had a cervicothoracic syrinx and a thoracic spinal cord tumor. We believe the syrinx interrupted fibers subserving itch, resulting in dermatomal pruritus with secondary scratching and a rash.

[Atopic neurodermatitis]. / Neurodermitis atopica.

Neurodermatitis atopica is a skin disease caused by various different factors and which is characterized by the simultaneous presence of different clinical features. The treatment is directed towards the various aetiopathological factors and oriented on the clinical picture. The main symptom is dry skin, which has to be rehydrated and provided with an artificial film of grease. Dermosteroids are the most efficient antiinflammatory agents, but they can only be used as one of various components of a complete neurodermatitis therapy. New knowledge gained over the past few years has shown the important role of Staphylococcus aureus in this condition, and as a result antibiotic therapy has increased in importance. The use of soap, which was previously not recommended, is now considered to be a useful and beneficial addition to the treatment, thanks to the availability of new alkali-free, disinfectant soaps. In certain cases there is a causal connection with exposure to allergens. Besides treatment of the itching, which is crucial for the patient, stabilization of the psychological factor and, if necessary, changes in the patient's environmental situation are extremely important. Substitution of essential fatty acids and UV therapy are discussed.

[The functional status of the sympathetico-adrenal system in patients with neurodermatitis and prurigo]. / Funktsional'noe sostoianie simpatiko-adrenalovoi sistemy u bol'nykh neirodermitom i pochesukhoi.

Studies of the urinary catecholamine excretion in the patients with neurodermatitis and prurigo have revealed dysfunction of the sympathoadrenal system, the severity of disorders depending on the disease gravity, dissemination, and length.

Neurogenic inflammation in the skin of the rabbit.

A flare-like spread of vasodilatation can be demonstrated in the limb skin of the anaesthetised rabbit using laser doppler flowmetry. Spread of dilatation from a small mechanical injury (nicking the skin) extends 5-10 mm. The size and time course of the dilatation are as expected from the low frequency C-nociceptor firing that occurs in response to similar nearby injury. Since C-nociceptors cause significant vasodilator responses at frequencies less than 1 Hz, it is proposed that they may often have a pro-inflammatory action without producing any reflex or sensory effects.

[Electrophysiological research on pain and itching in the clinic]. / Elektrofiologicheskoe issledovanie boli i zuda v klinike.

To study the central mechanisms of pain and itching, the authors performed electroencephalographic (EEG) examination in acupuncture-treated patients with diffuse neurodermatitis (n = 43) and trigeminal neuralgia (n = 25). The most characteristic EEG finding was increased synchronization of the cortical rhythm. The revealed EEG features point to the functional involvement of the thalamocortical system in the development of pain and itching. Changes of clinical and electrophysiological parameters in the course of acupuncture treatment is an additional evidence of the morphofunctional unity of the development of pain and itching.