British Journal of Dermatology (1973) 89, 625.

Atopy in lichen simplex (neurodermatitisdrcumscripta)

GURMOHAN SINGH

Head, Section of Skin and Venereal Disease, Institute of Medical Sciences, Banaras Hindu University, India

Accepted for publication 7 May 1973 •

SUMMARY

A Statistical study of 102 patients with lichen simplex lesions and a large group of controls shows asignificant association between this disease and a personal and family history of atopic disorders.

This communication compares the prevalence of a personal and family history of atopy in patientswith lichen simplex with that in a control group.

MATERIAL AND METHOD

Patients were unselected. A detailed inquiry was made to elicit any history of atopy in the patient orhis relatives.

A clinical diagnosis of lichen simplex was made when the patient had lesions on the nape of theneck, ulnar border of the forearm, pretibial area and other sites which are easily accessible to rubbingand scratching. In the present study group the following sites were involved (Table i).

TABLE

Site involved

Neck onlyUlnar border of one forearmUlnar border of both forearmsPretibial skinPretibial skin, forearm and neckNeck and forearmNeck and legNeck and armArm and leg

Total

I.

No. of patients

4915I I86332

5102

Percentage

4 8 114710878592-92 92-0

491000

A random sample of iooo control subjects from the Skin and Venereal Disease Outpatients Depart-ment and the General Medical wards of the hospitals, who had attended for any disease other thanpsychogenic or allergic, were similarly interviewed (Singh, 1972).

F 625

626 Gurmohan Singh

RESULTS

Table 2 shows the incidence of personal allergic manifestations in patients and controls.

TABLE 2. Showing incidence of different allergic manifestations in cases oflichen simplex and controls.

Allergicmanifestations

Asthma 'Allergic rhinitisUrticaria, recurrentUrticaria, evanescentNon-allergicConcomitant (two or more)

allergic manifestations

Lichensimplex

(i02 patients)

No. %

i6 15727 2657 6-9

13 12752 509

13 127

Controls(1000patients)

No. %

64 64154 15-445 4566 66

738 738

67 67

Z

25206245230 9126i-8io84-58

P

<0 02<0 02>O36>0 01

<0 0I

Statistical analysis(1) The incidence of asthma and allergic rhinitis in patients with lichen simplex is significantly higherthan in controls.(2) There is no significant difference in the incidence of a personal history of urticaria (either re-current or evanescent) in the two groups.(3) The percentage of subjects lacking a personal history of allergy is higher in the controls ascompared to patients with lichen simplex. The difference is highly significant.

A family history of atopy was present in forty-five subjects (44-1%). Table 3 shows the familyhistory of atopy in patients with lichen simplex and in controls.

TABLE 3.

Group No. of subjectsstudied

No. with positivefamily history

Percentage

(a) Lichen simplex(b) Control group as a whole(c) Controls with history of one

or more allergic manifestations

1 0 2

1000

313

45170

109

4 4 117-0

348

Statistical analysis(1) When (a) and (b) are compared by applying the Chi square test, the value of x^ is 41-63. Tablevalues of P for one degree of freedom are <o-ooi; The difference is therefore highly significant.(2) On comparing (a) and (c), the Chi square is 2-4626 and the table values of P for one degree offreedom are < o i o . The difference is not significant.

DISCUSSION

The lesions seen in lichen simplex are similar to those seen in atopic dermatitis (also called Besnier'sprurigo and neurodermatitis disseminata). There is, however, a difference in severity and sites of

Atopy in lichen simplex 627

involvement. In atopic dermatitis the lesions are usually bilateral and involve the ante-cubital andpopliteal fossae, the neck and other flexural areas. Patients with atopic dermatitis have a high inci-dence of other atopic manifestations, such as asthma and allergic rhinitis, and there is frequently avery strong family history of atopy.

Morphological similarities between the individual lesions of atopic dermatitis and of lichen simplexsuggest that these two entities may in some way be related to each other.

The data analysed indicate that a larger percentage of subjects with lichen simplex had atopicmanifestations as compared to controls who were not suffering from atopic disorders. The differenceswere statistically significant.

The history of atopy in members of the family, which included parents, siblings and children,was positive in 44-1% of patients as compared to 17-0% in controls. These differences were statistic-ally highly significant. The association with atopy is further supported by comparing the incidenceof atopy in families of patients with lichen simplex with that of the group of control subjectswho had given a positive personal history of one or more atopic manifestations; they were notsignificantly different.

These results differ from those of Carr, Berke & Becker (1964), who made the only other investiga-tion on this subject of which we are aware. They studied fifty-three subjects with lichen simplex andfound no significant increase in the atopic background as compared to a control population. Un-fortunately, they gave no criteria for the diagnosis of lichen simplex. A diagnosis of lichen simplexis made by some dermatologists only when the patient gives no history of atopy. If a clear historyof atopy (personal or familial) is elicited, the diagnosis is recorded as atopic dermatitis. Sulzberger eta/. (1961) also have stated that the absence of other findings of atopy helps to distinguish cases oflichen simplex from atopic dermatitis. If the lack of history of atopy is taken as a criterion for thediagnosis of lichen simplex, it is evident that the cases to which he applies this diagnosis are thosewithout an atopic background. This deliberate though unconscious selection of patients may explainthe findings of Carr et al. (1964).

ACKNOWLEDGMENTS

I am thankful to Dr K.N.Udupa, M.S., F.R.C.S., Director, Institute of Medical Sciences,Banaras Hindu University, for providing facilities and permission to publish this report. My thanksare also due to Mr N.S.Murthy, Lecturer in Statistics, for helping in statistical analysis.

REFERENCES

CARR, R.D., BERKE, M . & BECKER, S.W. (1964) Incidence of atopy in patients with various neurodermatoses.Archives of Dermatology, 89, 20.

SINGH, G . (1972) Prevalence of atopy. Paper presented at Vlth Annual Convention of Indian College of Allergyand Applied Immunology held at Varanasi in October-November, 1972.

Stn.ZBERGER, W.B., WOLF, J., WITTEN, V . H . & KOPF, A . W . (1961) Dermatology: Essentials of Diagnosis andTreatment. Year Book Publishers, Chicago.