LICHENIFICATION Treatment

Lichenification (neurodermatitis) has already been mentioned as a sequel to any kind of eczema when it is produced by the patient rubbing and scratching the irritable skin. It can start in any skin lesion which the patient feels compelled to rub such as a cut, scratch, graze, burn, pimple, patch of herpes simplex and so on. It thus results from obsessive interference with the skin, hence the name neurodermatitis. It is possible that primary patches can appear in response to itch produced under emotional stress. It is a self-perpetuating phenomenon because the rubbing eventually gives rise to further itch and further rubbing is evoked. This vicious circle may be attacked at several points: the pruritic threshold can be raised by giving sedatives by mouth, such as a combination of amylobarbitone 50 mg. and promethazine hydrochloride 12-5 mg. ; if practicable, the itchy part can be occluded with a bandage which is kept in place for a week or more at a time; treatment by tar can be combined with the occlusion or used alone ; corticosteroids can be used by inunction or, if the patch is chronic and localized, by injection into the lesion, or betamethasone valerate or fluocinolone acetonide can be used locally under polythene occlusion. Another measure to be considered is diverting the patient's attention to a hobby, and psychotherapy may be justified. Radiotherapy has hitherto been a routine method but it is now avoided if possible, particularly in those of childbearing age.