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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

Reference

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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]  

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