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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

  • Dupilumab is a new option for generalized disease or prurigo nodularis, its related condition

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

  • If specialized treatment is necessary

References

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Calugareanu  A  et al; French Group of Research and Study in Atopic Dermatitis (Groupe de Recherche sur l'Eczéma Atopique, GREAT) from the French Society of Dermatology (SFD). Effectiveness and safety of dupilumab for the treatment of prurigo nodularis in a French multicenter adult cohort of 16 patients. J Eur Acad Dermatol Venereol. 2020 Feb;34(2):e74–e76.
[PubMed: 31529718]
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Jung  HM  et al. Less painful and effective intralesional injection method for lichen simplex chronicus. J Am Acad Dermatol. 2018 Dec;79(6):e105–6.
[PubMed: 30025827]
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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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