Summary
Definition
History and exam
Key diagnostic factors
- presence of risk 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
- dermatological disease
- systemic conditions causing pruritus
Diagnostic investigations
Investigations to consider
- skin biopsy
- patch testing
- potassium hydroxide preparation
- fungal culture
- skin scrapings
- serum TSH and free T4
- serum creatinine and urea and electrolytes
- LFTs and gamma-GT
- FBC
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.
References
Key articles
Lotti T, Buggaiani G, Prignano F. Prurigo nodularis and lichen simplex chronicus. Dermatol Ther. 2008;21:42-46.Full text Abstract
Primary Care Dermatology Society. Lichen simplex (syn. circumscribed neurodermatitis). Jun 2022 [internet publication].Full text
van der Meijden WI, Boffa MJ, Ter Harmsel B, et al. 2021 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol. 2022 Jul;36(7):952-72.Full text Abstract
American College of Obstetricians and Gynecologists. Practice bulletin no. 224: diagnosis and management of vulvar skin disorders. Jul 2020 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Hypertrophic lichen planus
- Hypertrophic actinic keratoses
- Squamous cell carcinoma of the skin
More DifferentialsGuidelines
- Lichen simplex (syn. circumscribed neurodermatitis)
- European guideline for the management of vulval conditions
More Guidelines
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