Lichen Simplex Chronicus

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, and genitals

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

DIAGNOSIS

• Clinical

TREATMENT

Medications

• See Table 6–2

• For lesions in extragenital regions, 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

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