Neurodermatitis (Lichen Simplex Chronicus) 神经性皮炎

A 45-yr-old female felt nameless hot sensation and itch somewhere after her regular faical treatment, she thought it comes and goes as usual before her menstruation. But this time, itch is constant, rashes developed on her neck area one week later. She received diagnoses of neurodermatitis (Lichen Simplex Chronicus) at dermatologiest office. She expected antihistamine medication fix her itch, but unfortunately, it did not work. She tends to have itch worst at late night, her neck would be red and raw from scratching.

Over the past 10 months, she had seens several physicians, she was given corticorsteroids to suppress the inflammation, then followed by aggressive moisturizer to heal the skin barrier. She was administered with oral steroids prednisolone, sometimes antidepressants like mirtazapine added on. Steroids worked great on her initially, but whenever she stopped using the steroids, her dermatitis would come back worse. She came to realize she needed additional help, she sought a third-party opinion.

Scientitis studies report that neurodermatitis of the nape of the neck (lichen nuchae) is usually seen in women. The plaque may be limited to a small area around the midline of the nape or may extend some distance into the scalp and over the neck. Scaling is often profuse and psoriasiform, and episodes of secondary infection are frequent. Lichenification requently occurs as a manifestation of atopic eczema [1] but is not always present and lichen simplex occurs in many individuals who show no stigmata of atopy. In a predisposed individual, emotional tensions play a cruial role in promoting the development of lichen simplex and ensuring its perpetuation [2]. Neurodermatitis seems to be associated with certain genes, which, however, do not necessarily cause it.

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The patient came to our clinic seeking herbal medication management. She followed our advice to take herbal medicine twice daily, and her progress was monitored every eight weeks through photographs. Meanwhile, she began to avoid certain triggers, such as alcohol and staying up late at night. The herbal medicinal powder helped to manage her itching, which was limited to nighttime and more manageable. The patient’s skin condition continued to improve, and the solid plaques that had formed initially, with a warty, cribriform surface, flaked off after eight months of treatment. At 12 months, a significant improvement in the lesions was observed, and the prescription was discontinued at month 15. The patient was followed up for an additional 12 months, during which time there was no recurrence of lesions.

Reference:

  1.  Singh G. Atopy in lichen simplex (neurodermatitis circumscripta). Br J Dermatol1973;88:625–7.
  2. Cormia FE. Basic concepts in the production and management of the psychosomatic dermatoses – II. Br J Dermatol 1951;63:129–51.