International Journal of Trichology International Journal of Trichology
 Print this page Email this page Small font sizeDefault font sizeIncrease font size
  Home | About IJT | Editorial board | Search | Ahead of print | Current Issue | Archives | Instructions | Online submission | Subscribe | Advertise | Contact us | Login   

 Table of Contents  
Year : 2013  |  Volume : 5  |  Issue : 2  |  Page : 94-96  

A case of neurodermatitis circumscipta of scalp presenting as patchy alopecia

Department of Dermatology, MVJ Medical College and Research Hospital, Bangalore, Karnataka, India

Date of Web Publication12-Dec-2013

Correspondence Address:
H Ambika
F002, The Canopy Apartments, Agara Main Road, Babusahebpalaya, Kalyan Nagar, Bangalore - 560 043, Karnataka
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-7753.122971

Rights and Permissions

Neurodermatitis or Lichen simplex chronicus (LSC) is chronic skin disease in which emotional factors have a key role in the initiation of disease. A sixty year old lady presented with itcy lesion of scalp with localised area of loss of hair. After proper history taking and investigations she was diagnosed as LSC of scalp. She was treated with intralesional steroids,oral doxepin and psychotherapy. Complete remission of symptoms with total regrowth of hair occured in 3 months.The key role of emotional factors in causation of LSC and a proper psychotherapy along with dermatological treatment is necessary for complete cure of this condition.

Keywords: Neurodermatitis, scalp, patchy alopecia

How to cite this article:
Ambika H, Vinod C S, Sushmita J. A case of neurodermatitis circumscipta of scalp presenting as patchy alopecia. Int J Trichol 2013;5:94-6

How to cite this URL:
Ambika H, Vinod C S, Sushmita J. A case of neurodermatitis circumscipta of scalp presenting as patchy alopecia. Int J Trichol [serial online] 2013 [cited 2023 Mar 29];5:94-6. Available from: https://www.ijtrichology.com/text.asp?2013/5/2/94/122971

   Introduction Top

Neurodermatitis circumscripta also commonly called as lichen simplex chronicus (LSC) is a chronic skin disease characterized by lichenified plaques, which occur as result of constant scratching or rubbing of skin. Itch sensation that provokes an intense desire to scratch or rub a localized accessible area of skin is secondary to a psychological stress. Common sites are nape of neck, ankles, anogenital region and scalp. Effective management of skin conditions involves correction of the associated emotional factors.

   Case Report Top

The present case report is about a 60-year-old female patient who presented to dermatology out-patient department with itchy scalp lesion of 2 years duration. She also had complaints of localized loss of hair in that area. There was no history of any local applications. There was no history of any drug intake. On examination, there was a localized area of alopecia of 4 cm × 4 cm size with underlying skin showing marked thickening to form a boggy swelling [Figure 1] on the right parietoccipital region. There were no other skin lesions or hair and nail changes. Systemic examination was within the normal limits. Provisional diagnosis of LSC of scalp and tinea capitis was made. Woods lamp examination was negative and potassium hydroxide mount did not reveal any fungal hyphae. Routine blood and urine investigations, blood sugar, liver, renal and thyroid functions were normal. On further interrogation patients bystanders gave a history that patient at times uses rock stones to rub scalp and may continue rubbing until it bleeds. Skin biopsy revealed hyper keratosis hypergranulosis acanthosis thickening of collagen in dermis suggesting LSC. Patient was given intralesional injection of triamcinolone acetonide 2.5 mg/ml weekly for 4 weeks along with doxepin hydrochloride 10 mg at night. Patient was referred to Psychiatry Department for counseling. There was marked reduction in itching in the 1 st week and complete regrowth of hair at end of 4 weeks. Doxepin was stopped after 3 months [Figure 2] and [Figure 3]. Patient came for follow-up monthly thereafter for 6 months with no relapse [Figure 4].
Figure 1: Boggy swelling with loss of hair

Click here to view
Figure 2: Partial growth after 2 months

Click here to view
Figure 3: Total regrowth after 3 months

Click here to view
Figure 4: After 6 months no recurrence

Click here to view

   Discussion Top

Psychogenic factors play a key role in the initiation of pruritic sensation in LSC. [1] Itch scratch cycle is paroxysmal and patient scratches until it pains or bleeding occurs. This self-perpetuating mechanism is the main pathogenesis of LSC. [2] Skin lesions are that of a chronic eczema characterized by lichenified plaques. Most common sites are nape of neck, ankle, scalp and anogenital region. [3] Emotional tension causes lichen simplex and in turn patients with LSC in particular areas of the body (face, scalp, hands and genital area) are more prone to psychological distress due to the appearance of lesions. Although not life-threatening, it can produce an important psychosocial burden, sleep disturbance and sexual dysfunction. [4] Overall dermatology life quality index was lower in one study in patients with neurodermatitis than psoriasis. [5] Personality profiles of 60 patients with LSC were compared to a normative sample of the normal Spanish population, who were free of any kind of skin disease. Participants with LSC presented personality characteristics that differed from the control group. The most significant variables were as follows: greater tendency to pain-avoidance, greater dependency on other peoples' desires and more conforming and dutiful compared to the control group. [6] Effective management of skin conditions involves simultaneous correction of psychological factors else recurrence is the rule.

Complications like secondary infection and occurrence of squamouscell carcinoma is also reported in studies. [7] Topical treatment modalities for LSC with varying success are potent topical steroids, intralesional steroids, [8] keratolytic agents such as salicylic acid, capsacin, tacrolimus pimecrolimus and cryotherapy. Systemic modalities of treatment include sedative antihistamines, tricyclic antidepressants and psychotherapy. Transcutaneous electric nerve stimulation has been reported to be effective in reducing itch. [9] Botulinum toxin [10] and topical doxepin cream are also reported useful. [11]

   References Top

1.Chuh A, Wong W, Zawar V. The skin and the mind. Aust Fam Physician 2006;35:723-5.  Back to cited text no. 1
2.Agrawal SK, Khurana S. Lichen simplex. Indian Pediatr 2005;42:388.  Back to cited text no. 2
3.Rajalakshmi R, Thappa DM, Jaisankar TJ, Nath AK. Lichen simplex chronicus of anogenital region: A clinico-etiological study. Indian J Dermatol Venereol Leprol 2011;77:28-36.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Ermertcan AT, Gencoglan G, Temeltas G, Horasan GD, Deveci A, Ozturk F. Sexual dysfunction in female patients with neurodermatitis. J Androl 2011;32:165-9.  Back to cited text no. 4
5.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. 5
6.Martín-Brufau R, Corbalán-Berná J, Ramirez-Andreo A, Brufau-Redondo C, Limiñana-Gras R. Personality differences between patients with lichen simplex chronicus and normal population: A study of pruritus. Eur J Dermatol 2010;20:359-63.  Back to cited text no. 6
7.Wu M, Wang Y, Bu W, Jia G, Fang F, Zhao L. Squamous cell carcinoma arising in lichen simplex chronicus. Eur J Dermatol 2010;20:858-9.  Back to cited text no. 7
8.Vasistha LK, Singh G. Neurodermatitis and intralesional steroids. Dermatologica 1978;157:126-8.  Back to cited text no. 8
9.Yüksek J, Sezer E, Aksu M, Erkokmaz U. Transcutaneous electrical nerve stimulation for reduction of pruritus in macular amyloidosis and lichen simplex. J Dermatol 2011;38:546-52.  Back to cited text no. 9
10.Messikh R, Atallah L, Aubin F, Humbert P. Botulinum toxin in disabling dermatological diseases. Ann Dermatol Venereol 2009;136 Suppl 4:S129-36.  Back to cited text no. 10
11.Thomson KF, Highet AS. 5% doxepin cream to treat persistent lichenification in a child. Clin Exp Dermatol 2001;26:100.  Back to cited text no. 11


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

This article has been cited by
1 Scalp dysaesthesia and lichen simplex chronicus: diagnostic and therapeutic update with literature review
M. Starace, M. Iorizzo, V. D. Mandel, F. Bruni, C. Misciali, Z. Apalla, T. Silyuk, G. Pellacani, A. Patrizi, B. M. Piraccini, A. Alessandrini
Clinical and Experimental Dermatology. 2021;
[Pubmed] | [DOI]
2 Scabies-induced lichen simplex chronicus misdiagnosed as psychogenic pruritus: a case report
Ozzy M. Emmanuel, Ana V. Karovska, Okey Ikedilo
Journal of Medical Case Reports. 2021; 15(1)
[Pubmed] | [DOI]
3 Lichen simplex chronicus on the scalp: Broom fibers on dermoscopy; gear wheel sign and hamburger sign on histopathology
Sandip Agrawal, Rachita Dhurat, Smita Ghate, Aseem Sharma, Ravina Surve, Sanober Daruwalla
Indian Dermatology Online Journal. 2020; 11(3): 401
[Pubmed] | [DOI]
4 Cicatricial Alopecia with Particular Trichoscopic and Histopathological Features
Helena Rocchetto, Carolina OliveiraCostaFechine, Alessandra Anzai, Andreia Munck, Adriana RochettoAssalin, NeusaYuricoSakai Valente, Ricardo Romiti
Skin Appendage Disorders. 2019; 5(3): 193
[Pubmed] | [DOI]
5 Trichoteiromania: Good Response to Treatment with N-Acetylcysteine
CorinaIsabel Salas-Callo, Rodrigo Pirmez
Skin Appendage Disorders. 2019; 5(4): 242
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
   Case Report
    Article Figures

 Article Access Statistics
    PDF Downloaded41    
    Comments [Add]    
    Cited by others 5    

Recommend this journal