Lichen simplex of the scrotum

El liquen simple también se conoce como liquen simple crónico y neurodermatitis. El liquen simple del escroto también se conoce como liquen simple de los genitales masculinos .

Who gets lichen simplex from the scrotum?

El liquen simple del escroto se diagnostica con mayor frecuencia en hombres de entre 35 y 50 años.  El liquen simple del escroto, también conocido como liquen escleroso del escroto, es una afección de la piel que se caracteriza por placas duras, escamosas y de color blanco o marrón en el escroto. Puede afectar a hombres de cualquier edad, pero es más común en adultos mayores. La causa exacta de esta afección no se conoce, pero se cree que puede estar relacionada con una respuesta autoinmune o una reacción alérgica a ciertos productos químicos.

What causes lichen simplex of the scrotum?

Lichen simplex of the scrotum is attributed to a persistent itch-scratch cycle. Underlying pruritus, a cutaneous or systemic condition or neuropathy or psychiatric the disorder may induce intractable scratching leading to hypertrophy de la piel escrotal. Los factores contribuyentes al liquen simple escrotal pueden incluir:

• Underlying atopic dermatitis
• Other pruritic skin disorder (eg, Psoriasis or lichen planus)
• Contact with a irritating (Irritant Contact Dermatitis) - Often triggered by heat, sweating, friction from clothing, or excessive use of cleansers or current medicines
• Contact with a allergen (allergic contact dermatitis)
• Cutaneous infection - usually of fungal origin, usually either candidiasis or a dermatophyte fungus (ringworm)
• Psychiatric disorder (eg, anxiety or haunting–compulsive disorder)
• A benign or evil one skin tumor (e.g, scaly cell carcinoma)
• Located neuropathic chop
• A systemic cause of generalized itching (eg. renal failure, obstructive biliary disease, hyperthyroidism or hypothyroidismor Hodgkin lymphoma)

What are the clinical features of lichen simplex scrotum?

Lichen simplex of the scrotum manifests with a clearly delineated thickening of the scrotum skin with hypopigmentation and hyperpigmentation and variable scale. It is often unilateralbut it can also be bilateral. Coalescent papules formar placas solitarias o múltiples. Otras características pueden incluir:

• Excoriations and fissures
• Exaggerated skin lines
• Variable degrees of erythema
• A shortage of hair; or short, broken stems.

Signs of an underlying skin disorder may also be seen. adjacent to lichen simplex on the scrotum and elsewhere on the body.

More areas of lichen simplex can also be found, most commonly on the neck, scalp, extensor muscle superficies de las extremidades, o la parte inferior de las piernas y los tobillos.

What are the complications of lichen simplex of the scrotum?

Complications of lichen simplex scrotum may include:

• Insomnia or poor sleep quality: sleep studies have revealed sleep disturbances due to chronic scratching during sleep
• Secondary bacterial infection (eg, impetigo or cellulite)
• Send-inflammatory hyperpigmentation or hypopigmentation and, rarely, permanent white marks (leukoderma)
• Fibrosis and scars from repeated scratching
• Structural distortion of the genitalia (rarely).

También se sospecha que el liquen simple del escroto contribuye a reducir la fertilidad .

Adverse effects of treatment may also arise, particularly atrophy due to the prolonged use of a powerful topical corticosteroid on thin scrotal skin. Topical steroids can also cause pigmentation abnormalities.

How is lichen simplex of the scrotum diagnosed?

The clinical features of lichen simplex scrotum are generally sufficient to establish the diagnosis. When the findings are atypical, more tests may be considered to make a definitive diagnosis or to exclude other similar ones skin disease; Such tests to consider include:

• A skin biopsy
• A skin swab for bacteria and candida
• Mushroom scraping for dermatophyte fungi
• Patch test, if allergic contact dermatitis is suspected [3,4].

If simple scrotal lichen is associated with generalized pruritus, treatment for systemic causes may be performed (as described on our pruritus page).

Which is the differential diagnosis for simple lichen of the scrotum?

Otros trastornos que deben considerarse en un paciente con liquen simple del escroto incluyen :

• Lichen atopic eczema
• Ringworm
• Prurigo nodularis
• Psoriasis
• Lichen planus
• Lichen sclerosus
• Mycosis fungoides
• Nodular pemphigoid
• Condyloma related to human papilloma virus (HPV)
• Skin lesions, tumors and cancers.
• Lumbosacral radiculopathy.

What is the treatment for lichen simplex of the scrotum?

The main goals of treating lichen simplex scrotum are:

• Avoiding exacerbate factors
• Break the itch-scratch cycle
• Treatment of any underlying skin disease or predisposing condition
• Restoration of the normal skin barrier.

Short-term topical corticosteroids are used as first-line therapy to break the itch-scratch cycle. Treatment principles for lichen simplex scrotum include the use of medium potency topical steroids such as triamcinolone. ointment hasta que haya una resolución de las lesiones activas. Si la enfermedad es refractaria después de 2 a 3 semanas de un corticosteroide de potencia intermedia, se pueden usar esteroides tópicos más potentes a corto plazo. A medida que la afección mejora, la frecuencia de aplicación y la potencia del corticosteroide deben disminuirse para minimizar los efectos adversos.

Aim to repair the skin's barrier function with frequent application of emollient creams and moisturizers. Minimize environmental triggers like:

• Dryness
• Sweating or excessive humidity.
• Skin friction from tight or rough materials.

Identify and treat underlying disorders that cause or worsen lichen simplex scrotum. [2–5]. Other treatment recommendations include the following.

• Reduce or stop using soap, non-prescription topical medications, and wipes.
• Add a barrier cream to protect the skin
• Treat any underlying inflammatory dermatosis, infection, or systemic cause of itching.
• Treat psychiatric conditions, such as depression, anxiety, or obsessive compulsive disorder, with appropriate pharmacotherapy (eg, tricyclic antidepressants or selective serotonin reuptake inhibitors) and psychological therapy.
• Radiculopathy can be managed with tricyclic antidepressants or antiepileptic drugs.

What is the result of lichen simplex of the scrotum?

El curso clínico del liquen simple escrotal es crónico y prolongado, y los pacientes pueden sufrir indefinidamente sin el tratamiento adecuado. A medida que se producen recurrencias durante el estrés psicológico o el brote de dermatosis subyacentes, en algunos pacientes puede ser necesario un tratamiento a largo plazo.