Summary
Definition
History and exam
Key diagnostic factors
- underlying dermatosis
- pruritus beginning during psychological stress
- severe intractable itching
- lichenification
- erythematous to violaceous plaques
- lesions on neck, ankles, scalp, vulva, scrotum, pubis, and extensor forearms
Other diagnostic factors
- altered pigmentation
- erosions
- linear fissures
- grouped hyperpigmented papules on the shins
- hyperpigmented patch on the interscapular back
- underlying psychiatric disorder
- underlying systemic condition causing pruritus
Risk factors
- atopic diathesis
- environmental irritants
- psychiatric disorder
- dermatologic disease
- systemic conditions causing pruritus
Diagnostic tests
Tests to consider
- skin biopsy
- patch testing
- potassium hydroxide preparation
- fungal culture
- skin scrapings
- serum TSH and free T4
- serum creatinine and BUN and electrolytes
- LFTs and gamma-GT
- CBC
Treatment algorithm
adults and children ≥12 years
children <12 years
Contributors
Authors
Brian L. Swick, MD
Clinical Professor
University of Iowa Departments of Dermatology and Pathology
Iowa City Veterans Affairs Medical Center
Iowa City
IA
Disclosures
BLS declares that he has no competing interests.
Peer reviewers
Gil Yosipovitch, MD, FAAD
Professor
Stiefel Chair of Medical Dermatology
Director Miami Itch Center
Dr Phillip Frost Department of Dermatology and Cutaneous Surgery
Miller School of Medicine
University of Miami
Miami
FL
Disclosures
GY is an advisory board member for Abbvie, Arcutis, Escient Health, Eli Lilly, Galderma, LEO Pharma, Novartis, Pfizer, Pierre Fabre, Regeneron Pharmaceuticals, Inc., Sanofi, Vifor, GSK, and Kamari. He has received grants/research funding from Eli Lilly, LEO Pharma, Novartis, Pfizer, Galderma, Escient, Sanofi Regeneron, and Celldex. GY is an investigator for Regeneron Pharmaceuticals, Inc., and Sanofi.
Helen Goodyear, MBChB, MRCP, FRCPCH, MD, MMed
Consultant Paediatrician
Heartlands Hospital
Birmingham
UK
Disclosures
HG declares that she has no competing interests.
Differentials
- Hypertrophic lichen planus
- Hypertrophic actinic keratoses
- Squamous cell carcinoma of the skin
More DifferentialsGuidelines
- European guideline for the management of vulval conditions
- Lichen simplex (syn. circumscribed neurodermatitis)
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