LIKEN SIMPLEKS KRONIK

LIKEN SIMPLEKS KRONIKDef: Peradarangan kulit kronis yang desertai rasa gatal sangat, ditandai dengankulit tebal dan relief kulit lebih menonjol menyerupai kulit batang kayu, akibat garukan / gosokan yang berulang.(Djuana, Suria; UI, Ilmu Penyakit Kulit dan Kelamin)

Sinonim: lichen simplex chronicus, neurodermatitis circumscripta, circumscribed neurodermatitis, lichen simplex chronicus of Vidal, LSC, lichen amyloidosis. (Hogan, Daniel; LSC; www.emedicine.com)

Epidemiology:

-Jarang pada anak

-Insidensi tertinggi: usia 30-50 thn

-F>M

-Lichen nuchae: bentuk lichen simplex yang terjadi pada midposterior leher,khususnya wanitaEtiologi dan Patogenesis:

-Penyebab blum diketahui pasti

-Pruritus( stimulus utama

-Hipotesa pruritus: a) Gangguan medis (underlying medical disorder): gagal ginjal kronis; penyakit obstruksi biliar; limfoma Hodgkin, Polycythemia rubra vera, hyperthyroidism, gluten sensitive eneteropathy (Celiac disease), HIV infection.

b) gangguan kulit yang berhubungan: dermatoses pruritus seperti dermatitis allergik kontak, gigitan serangga, dermatitis statis.

c) proliferasi nervus:

d) aspek psikologis (emotional tension).[ Fitzpatrick]e)

Gejala Klinis:

1)Riwayat penyakit: Patients with lichen simplex chronicus usually describe stable pruritic plaques on one or more areas; however, thickening of the skin occurs on any location that the patient can reach, including the following:

Scalp

Nape of neck

Extensor forearms and elbows

Vulva and scrotum3 Upper medial thighs, knees, lower legs, and ankles

Erythema is noted most in early lesions.

Pruritus is described as worse when patients are still or quiet and as much less or nonexistent when patients are active.

Pruritus is usually intermittent; the resultant scratching provides temporary relief.

Patients may have a past medical history of a chronic skin condition or acute trauma. Patients with atopic dermatitis may have lichen simplex chronicus in areas of former atopic outbreaks. Sites of irritant or allergic contact dermatitis, insect bites, or other past minor skin trauma sometimes demonstrate pruritus and, subsequently, lichen simplex chronicus.

Each palm-sized plaque may have 3 zones. A 2- to 3-cm wide peripheral zone that is barely thickened may have isolated papules. The middle zone has lenticular and hemispheric prurigo papules that may be excoriated. The central zone has the greatest thickening and pigmentary alteration.

2) Pemeriksaan fisik:

One or more slightly erythematous, scaly, well-demarcated, lichenified, firm, rough plaques with exaggerated skin lines are noted.

Pigmentary changes (especially hyperpigmentation) are seen variably as in any dermatitic lesion.

Rubbing plays a key role in lesion formation and is visualized variably by white scratch marks, erosion, and ulceration from deeper scratching.

Lichen simplex chronicus is one of the hyperkeratotic processes from which a cutaneous horn may grow.4