Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ 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 + +An JG, et al. Quality of life of patients with neurodermatitis. Int J Med Sci. 2013;10(5):593–8. [PubMed: 23533146] + +D'Erme AM, et al. Efficacy of treatment with oral alitretinoin in patient suffering from lichen simplex chronicus and severe atopic dermatitis of hands. Dermatol Ther. 2014 Jan–Feb;27(1):21–3. [PubMed: 24502306] + +Liao YH, et al. Increased risk of lichen simplex chronicus in people with anxiety disorder: a nationwide population-based retrospective cohort study. Br J Dermatol. 2014 Apr;170(4):890–4. [PubMed: 24372057] GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. What is MyAccess? Create a FREE MyAccess profile to: Use this site remotely Bookmark your favorite content Track your self-assessment progress and more! GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessMedicine 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessMedicine Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options