IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 3996 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
   [PDF Not available] *
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   Abstract
   Introduction
   Materials and Me...
   Results
   Discussion
   References

 Article Access Statistics
    Viewed4811    
    Printed86    
    Emailed3    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal

 


 
STUDIES
Year : 1995  |  Volume : 61  |  Issue : 6  |  Page : 336-338

Lichen simplex chronicus - A Psychocutaneous disorder?




Correspondence Address:
V D Sanjana


Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 20953014

Rights and PermissionsRights and Permissions

  Abstract 

Lichen simplex chronicus is classified as a skin disorder determined or influenced by emotional factors. This study was conducted to determine the involvement of the psyche in this psychocutaneous disorder. Forty six patients of lichen simplex chronicus were chosen for this study. The severity of pruritus was rated on a 10 point scale. They then underwent a psychiatric interview using the Hamilton anxiety-depression scale to quantitate their mental state. The numerical values of anxiety and depression did not exceed 50% of the measuring scale. This could be due to the 'venting' or exteriorisation of the inner turmoil, in this case by itching. The correlation between anxiety and pruritus and that of depression and pruritus was studied and it was surmised that depression may be related to pruritus compared to anxiety.


Keywords: Lichen simplex, Anxiety, Depression, Pruritus


How to cite this article:
Sanjana V D, Fernandez R J. Lichen simplex chronicus - A Psychocutaneous disorder?. Indian J Dermatol Venereol Leprol 1995;61:336-8

How to cite this URL:
Sanjana V D, Fernandez R J. Lichen simplex chronicus - A Psychocutaneous disorder?. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2019 May 23];61:336-8. Available from: http://www.ijdvl.com/text.asp?1995/61/6/336/4265



  Introduction Top


Lichen simplex chronicus (LSC) is a chronic skin disease which results due to a fixed conditioned response to itch.[1] Since histological picture shows nerve changes, it is often called neurodermatitis.[2] A strong psychogenic basis has been postulated by several researchers[3] as these lesions worsen during periods of fatigue and emotional stress[4] and improve with rest and relaxation. This study was carried out to assess whether the psyche was involved in this psychocutaneous disorder and the degree to which it is involved. The two parameters of psyche chosen in this study were anxiety and depression.


  Materials and Methods Top


Forty-six patients of LSC (age range-14 to 75 years, 28 men and 18 women) were inducted into this study. The severity of pruritus was rated on a 10 point scale.

0. No itching.

1. complained of when asked

2. complained of during rest hours in the day, occasionally.

3. complained of during rest hours in the day, paroxysmally.

4. complained of during rest hours in the day, continuously.

5. occurs during sleep.

6. wakes the patient up from sleep.

7. prevents sleep.

8. mild itching while at work.

9. distracts patient at work.

10. patient unable to concentrate at work.

Later they were subjected to a psychiatric interview, using the Hamilton anxiety-depression scale. This scale was devised by Max Hamilton of the University of Leeds.[5][6][7][8] The scale provides a simple way of assessing the severity of a patient's condition quantitatively and for showing changes in that condition. Other things being equal, the value of the rating depends entirely on the skill and experience of the rater and on how adequate is the information available to him.

Hamilton took 10 major categories commonly associated with depression



  1. 1. Depressed mood


  2. 2. Suicide


  3. 3. Loss of interest


  4. 4. Retardation


  5. 5. Agitation


  6. 6. Gastro-intestinal symptoms


  7. 7. Hypochondriasis


  8. 8. Insight


  9. 9. Loss of weight


  10. 10. General somatic symptoms




and subdivided them to provide 17 items. Symptoms are rated finely or coarsely; the former are on a 5 point scale (0-4) where the numbers are equivalent to absent, doubtful or trivial, mild, moderate and severe. The later on a 3 point scale (0-2) equivalent to absent, doubtful or mild and obvious, distinct or severe.

The Hamilton Anxiety scale is a 14 item scale

II Psychic Anxiety

1. Anxious mood

2. Tension

3. Fears

4. Insomnia

5. Intellectual

6. Depressed mood

7. Behaviour at interview

III Somatic Anxiety

8. Somatic, muscular

9. Somatic, sensory

10. Central nervous system symptoms

11. Respiratory system symptoms

12. Gastrointestinal symptoms

13. Genito-urinary symptoms

14. Autonomic symptoms

Assessments are made on a 5 point scale similar to the one in depression scale.


  Results Top


The numbers indicate numerical values of A-Anxiety and D-Depression of the patients.

Pruritus

rating

1. A - 4 - 0

D - 10 - 6

2. A - 2 - 2 - 14 - 2 - 8 - 4

D - 2 - 2 - 16 - 2 - 20 - 8

3. A - 4 - 12 - 6

D - 14 - 20 - 16

4. A - 46 - 8 - 2 - 10 - 10

D - 46 - 8 - 2 - 6 - 6

5. A - 26 - 4 - 6 - 6 - 0 - 0

D - 18 - 8 - 12 - 12 - 2 - 2

6. A - 2 - 0 - 0 - 8

D - 2 - 4 - 6 - 14

7. A - 12 - 2 - 2 - 2 - 22 - 4 - 30 - 0 - 8

D - 14 - 6 - 10 - 10 - 18 - 6 - 46 - 6 - 6

8. A - 4 - 4 - 0 - 8

D - 10 - 8 - 4 - 12

9. A - 8 - 10

D - 12 - 14

10. A - 6 - 18 - 2 - 26 - 4

D - 16 - 38 - 30 - 36 - 14

Statistical analysis suggested that anxiety or depression was the primary cause and pruritus was the dependant variable. Thus if anxiety values were plotted on x axis and pruritus values on y axis, some correlation was expected to prevail.

The degree of correlation between x and y axis 'r' was calculated using the following formula:

Where x = Anxiety or depression

y = Pruritus

/?/ = Mean of x values

/?/ = Mean of y values

n = total number of patients

δx = Standard deviation of x

δy = Standard deviation of y

Using the above formula for anxiety on x axis, r = 0.08.

and if depression is on x axis, r = 0.291.

For a perfect direct degree of correlation r = 1


  Discussion Top


The minimal and maximal values of anxiety or depression scale range from 0-112. The numerical values of anxiety and depression in our study do not exceed the level of even 50% of the measuring scale. This could also be because the stresses generated in the human system received some exteriorisation or so called 'venting' of the inner turmoil or imbalance.

It can be seen that the values of r in both cases is quite poor which is due to the fact that many other factors affecting pruritus levels in individuals, are interfering. Even then in all probability depression might be related more to pruritus compared to anxiety because 'r' value is higher in case of depression.

 
  References Top

1.Robertson IM, Jordan JM, Whitlock FA. Emotions and skin ll. Br J Dematol 1975;92:407.  Back to cited text no. 1    
2.Cowan MA. Neurohistological changes in lichen simplex chronicus. Arch Dermatol 1964;89:562.  Back to cited text no. 2  [PUBMED]  
3.Bethune HC, Kidd CB. Psychophysiological mechanism in skin disease. Lancet 1961;ii:1419.  Back to cited text no. 3    
4.Marks R. Psyche and skin disease. In:Practical problems in dermatology (Marks R, ed). 1st edn. London:Martin Dunitz Ltd. 1983;68-72.  Back to cited text no. 4    
5.Hamilton M A. Rating scale for depression. J Neurology Neurosurgery Psychiatry 1960;23:56.  Back to cited text no. 5    
6.Hamilton M. Comments of the Author -Adapted from development of a rating scale for primary depressive illness. Br J Socioclinical Psychology 1967;6:278-96.  Back to cited text no. 6  [PUBMED]  
7.Schwab JJ, Bialow RM, Clemmons RS, et ai. Hamilton rating scale for depression for medical in - patients. Br J Psy 1967;113:83-8.  Back to cited text no. 7    
8.Lader MH, Marks IM. A rating of clinical anxiety. Acta Psychiatrica Scandinvica 1974;50:112-37.  Back to cited text no. 8  [PUBMED]  




 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow