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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

Lichen simplex chronicus represents a self-perpetuating scratch-itch cycle that is hard to disrupt.

CLINICAL FINDINGS

Intermittent itching incites the patient to scratch the lesions. Itching may be so intense as to interfere with sleep. Dry, hypertrophic, lichenified plaques appear on the neck, wrists, ankles, or perineum (Figure 6–6) (eFigure 6–11) (eFigure 6–12). The patches are rectangular, thickened, and hyperpigmented. The skin lines are exaggerated.

Figure 6–6.

Lichen simplex chronicus on the hand. (Used with permission, from Lindy Fox, MD.)

eFigure 6–11.

Lichen simplex chronicus. (Used, with permission, from TG Berger, MD, Dept Dermatology, UCSF.)

eFigure 6–12.

Lichen simplex chronicus resulting from repeated itch-scratch cycles. Note the hypertrophic leathery, lichenified plaques. The exaggerated skin lines are characteristic. (Used, with permission, from S Goldstein, MD.)

DIFFERENTIAL DIAGNOSIS

This disorder can be differentiated from plaque-like lesions such as psoriasis (redder lesions having whiter scales on the elbows, knees, and scalp and nail findings) (eFigure 6–13), lichen planus (violaceous, usually smaller polygonal papules), and nummular (coin-shaped) dermatitis (eFigure 6–14). Lichen simplex chronicus may complicate chronic atopic dermatitis or scabetic infestation.

eFigure 6–13.

Psoriasis. (Used, with permission, from Lindy Fox, MD.)

eFigure 6–14.

Nummular dermatitis. (Used, with permission, from Lindy Fox, MD.)

TREATMENT

For lesions in extragenital regions, superpotent topical corticosteroids are effective, with or without occlusion, 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. Continuous occlusion with a flexible hydrocolloid dressing for 7 days at a time for 1–2 months may also be helpful. For genital lesions, see the section Pruritus Ani.

PROGNOSIS

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

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Chibnall  R. Vulvar pruritus and lichen chronic simplex. Obstet Gynecol Clin North Am. 2017 Sep;44(3):379–88.
[PubMed: 28778638]
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Jung  HM  et al. Less painful and effective intralesional injection method for lichen simplex chronicus. J Am Acad Dermatol. 2018 ...

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