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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 and may 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


  • Clinical



  • See Table 6–2

  • Ultra-high potency 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



  • 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


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;34:e74.
[PubMed: 31529718]  
Jung  HM  et al. Less painful and effective intralesional injection method for lichen simplex chronicus. J Am Acad Dermatol. 2018;79:e105.
[PubMed: 30025827]  
Qureshi  AA  et al. A systematic review of evidence-based treatments for prurigo nodularis. J Am Acad Dermatol. 2019;80:756.
[PubMed: 30261199]  

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