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Year : 1992  |  Volume : 58  |  Issue : 6  |  Page : 384-387

Evaluation of an antihistamine and an antidepressant for the treatment of lichen simplex chronicus

VD Sanjana, RJ Fernandez 
 

Correspondence Address:
V D Sanjana


Abstract

Twenty four patients of lichen simplex chronicus completed a double-blind trial to evaluate the therapeutic efficacy of an antihistamine (chlorpheniramine maleate), an antidepressant (imipramine), and a placebo. Imipramine was found to be superior to other 2 medications.



How to cite this article:
Sanjana V D, Fernandez R J. Evaluation of an antihistamine and an antidepressant for the treatment of lichen simplex chronicus.Indian J Dermatol Venereol Leprol 1992;58:384-387


How to cite this URL:
Sanjana V D, Fernandez R J. Evaluation of an antihistamine and an antidepressant for the treatment of lichen simplex chronicus. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2019 Jul 19 ];58:384-387
Available from: http://www.ijdvl.com/text.asp?1992/58/6/384/3858


Full Text

 Introduction



Lichen simplex chronicus (LSC) is characterized by the presence of lichenified plaques that develop after repeated rubbing or scratching. This is the result of a conditioned or learned response to itch. [1] Some workers [2],[3][4] have suggested a psychogenic basis as the cause of this condition.

Anxiolytics and antidepressants have been used recently [5] as adjunct in the therapy of LSC even in the absence of coexisting psychopathology. Their therapeutic effect may be mediated via their central or peripheral antihistaminic and anticholinergic actions. They may also help the patient by lightening the mood, correcting sleep patterns, and by creating a general sense of well-being. [6]

Tricyclic antidepressants have a marked effect on itching. Response to itching is relative to the response of depressive symptoms to the drug. This points to the hypothesis that itching is probably an expression of depression.

The degree of depression seen in psychocutaneous disorders is mild and will thus require a lower dose of antidepressants. [7] Therapeutic dermato­logic effect is noticeable in 2 to 4 weeks and antidepressant effect in 4 to 6 weeks as both are - mediated via different pharmacological properties.

This study was conducted to evaluate the therapeutic efficacy of an antihistamine, an antidepressant, and a placebo in LSC.

 Material and Methods



Chlorpheniramine maleate was chosen as the antihistamine for this study because it was inexpensive, easily available, and has a slight sedative property. Sodium bicarbonate was chosen as the placebo. Imipramine was chosen as the antidepressant as it is a prototype of tricyclic antidepressants.

Forty six patients of LSC (age range 14-15 years; 28 men, 18 women) were chosen for the study. Patients with concomitant dermatosis or medical disorders known to be associated with pruritus were not included. A wash out period of 2 weeks with Zinc Oxide paste was advised to those patients who were on treatment at the first meeting.

The severity of pruritus was rated on a 10 point scale as follows:

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, paroxysmal

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

Biopsy was taken to rule out psoriasiform tissue reactions. All patients were screened to exclude any contraindication to imipramine therapy (i.e., acute myocardial infarction, ischaemic heart disease, brain ischaemia, seizures and elderly patients as it precipitates glaucoma and urinary retention).

At the start of therapy all patients received a standard course of treatment. They were given a mild topical steroid cream (clobetasol- 17-butyrate 0.05%). This uniformity ensured that topical steroid efficacy was not being assessed in this study.

The selected subjects were divided into the following 3 groups:

group A, group B, and group C depending on whether the patients were receiving capsules A,B, or C respectively. Externally capsules A,B and C were indistinguishable. The patients were given these capsules in a . random order using randomisation charts for 6 weeks in a double blind trial using a standard dosage schedule as follows:

1st week-1 cap once . a day; 2nd week­1 cap twice a day; 3rd, 4th, 5th, and 6th week- 1 cap thrice a day.

Imipramine has to be given in gradual increments. Hence, initially in the first 2 weeks antihistaminic acts almost like a placebo as the therapeutic effect of this drug does not last for more than 6 to 8 hours. However, during weeks 3,4,5 and 6 its therapeutic efficacy can be assessed. In some cases a switch over was also done. A dermatological reassessment was obtained after 2,4, and 6 weeks. At the end of the trial capsule A was found to contain chlorpheniramine maleate (4mg), capsule B was found to contain sodium bicarbonate, and capsule C was found to contain imipramine hydrochloride (25mg).

Since the sample size of each group in our study was small, the students `t' test was used to test the statistical significance of the different groups.

 Results



Out of 46 patients who started the therapy only 24 patients completed 6 weeks of therapy. These patients had been put on the following: 5 received an antihistamine, 9 received a placebo, and 10 received an antidepressant. The results are shown in the tables.

 Comments



On comparing the therapeutic efficacy of antihistamine, placebo, and anti­depressant it can be stated that pruritus was definitely better controlled by imipramine though antihistamine or placebo do not lag behind in effectiveness. Since imipramine proved to be effective in treating LSC it can be concluded that there must be an underlying psychopathology present in LSC. Those patients receiving antihistamines or placebos could be more suggestible and once the patient believes in any course of treatment, the natural processes (of higher intelligence) could favour in reestablishing the disturbed balance of life.

It can be concluded by this study that if there are no contra-indications, imipramine can be given safely (mainly as a supplement to therapy) to patients of LSC particularly if long standing and recalcitrant or the pruritus is severe and distressing and not responding to conventional therapy of known repute.

References

1Robertson 1 M, Jordan J M, Whitelock F A. Emotions and skin. II. Br J Dermatol 1975; 92 407.
2Srivastava ON, Bhati VK, Singh G. A study of neuroticism in skin patients. Ind J Psychiatry 1975;17:37.
3Kumar B, Singh G, Jaiswal AN, et al. 'Needs' in patients of neurodermatitis circumscripta. Ind J Dermatol 1989; 46: 104.
4Kumar B, Singh G, Jaiswal AN. A study of neurodermatitis circumscripta patients with psychological tests. Ind J Dermatol 1982; 48 : 241.
5Gupta MA, Gupta AR, Ellis CN. Antidepressant drugs in dermatology. Arch Dermatol 1987; 123: 647-52.
6Gupta MA, Vorhees JJ. Psychosomatic dermatology: is it relevant? Arch Dermatol 1990; 126: 90-3.
7Goodman, Gilman. Tricyclic antidepressants. In: The pharmacologic Basic of Therapeutics (Goodman GA, Goodman L, Rall TW, eds), 7th edn. New York: Macmillan publishing company, 1985; 413-23.

 

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