Lichen simplex chronicus

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Lichen simplex chronicus
Diagnosis in short

Lichen simplex chronicus. H&E stain.

LM irregular psoriasiform change (acanthosis), hyperkeratosis, parakeratosis, +/-spongiosis
LM DDx prurigo nodularis, oral lichen simplex chronicus
Site skin

Clinical history scratching, irritation
Prevalence common
Prognosis benign

Lichen simplex chronicus, abbreviated LSC, a relatively common diagnosis in dermatopathology.

It is also known as squamous cell hyperplasia.[1]

In the oral cavity, it may go by the name benign alveolar ridge keratosis.[2]

General

Etiology:[5]

  • Pruritus (itchness) -> mechanical trauma -> lichenification (thickened/leathery[6].

Microscopic

Features:[7]

  • Acanthosis (epithelial thickening) - irregular.
  • Hyperkeratosis.

Other features:[8]

  • Spongiosis (epidermal intercellular edema -- cells appear to have a clear halo around 'em).
  • Parakeratosis = retention of nuclei in the stratum corneum.

DDx:

Images

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SKIN, PUNCH BIOPSY:
- LICHEN SIMPLEX CHRONICUS.
- NEGATIVE FOR MALIGNANCY.

Oral

RETROMOLAR PAD, RIGHT, PUNCH BIOPSY:
- ORAL LICHEN SIMPLEX CHRONICUS.
- NEGATIVE FOR MALIGNANCY.
ALVEOLAR RIDGE, RIGHT INFERIOR, BIOPSY:
- ORAL MUCOSA WITH SQUAMOUS CELL HYPERPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Micro

The sections show a squamous mucosa with irregular psoriasiform change, parakeratosis, and focal hypergranulosis. There is no inflammation at the interface. Epidermal intercellular bridges are easily seen. There is no significant nuclear atypia. Mitoses are not evident.

See also

References

  1. Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1011. ISBN 978-1416031215.
  2. 2.0 2.1 Natarajan, E.; Woo, SB. (Jan 2008). "Benign alveolar ridge keratosis (oral lichen simplex chronicus): A distinct clinicopathologic entity.". J Am Acad Dermatol 58 (1): 151-7. doi:10.1016/j.jaad.2007.07.011. PMID 18158926.
  3. Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 296. ISBN 978-0470519035.
  4. Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 26. ISBN 978-0443066542.
  5. URL: http://emedicine.medscape.com/article/1123423-overview. Accessed on: 20 August 2010.
  6. URL: http://www.medterms.com/script/main/art.asp?articlekey=10131. Accessed on: 20 August 2010.
  7. Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1065-6. ISBN 0-7216-0187-1.
  8. URL: http://emedicine.medscape.com/article/1123423-diagnosis. Accessed on: 20 August 2010.