Lichen Simplex Chronicus

Key Features

Essentials of Diagnosis

• Chronic itching and scratching

• Lichenified lesions with exaggerated skin lines overlying a thickened, well-circumscribed scaly plaque

• Predilection for nape of neck, wrists, external surfaces of forearms, lower legs, scrotum, and vulva

General Considerations

• A self-perpetuating scratch-itch cycle

• Intermittent itching incites the patient to scratch the lesions

• Itching may be so intense as to interfere with sleep

Clinical Findings

Symptoms and Signs

• Dry, leathery, hypertrophic, lichenified plaques appear on the neck, ankles, or perineum

• Patches are rectangular, thickened, and hyperpigmented

• Skin lines are exaggerated

Differential Diagnosis

• Psoriasis (redder lesions having whiter scales on the elbows, knees, and scalp and nail findings)

• Lichen planus (violaceous, usually smaller polygonal papules)

• Atopic dermatitis (eczema)

• Nummular eczema or dermatitis (coin-shaped)

• Tinea corporis

• Chronic atopic dermatitis

Diagnosis

• Clinical

Treatment

Medications

• See Table 6–2

• Super potent topical corticosteroids are effective with or without occlusion and when used twice daily for several weeks

• In some patients, flurandrenolide (Cordran) tape may be effective, since it prevents scratching and rubbing of the lesion

• The injection of triamcinolone acetonide suspension (5–10 mg/mL) into the lesions may occasionally be curative

Therapeutic Procedures

• Continuous occlusion with a flexible hydrocolloid dressing for 7 days at a time for 1–2 months may also be helpful

Outcome

Prognosis

• The disease tends to remit during treatment but may recur or develop at another site

When to Refer

• If there is a question about the diagnosis, if recommended therapy is ineffective, or if specialized treatment is necessary

References