Last reviewed: 30 Dec 2022
Last updated: 15 Oct 2019
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
More key diagnostic factors
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
Other diagnostic factors
Risk factors
- atopic diathesis
- environmental irritants
- psychiatric disorder
- dermatological disease
- systemic conditions causing pruritus
More risk factors
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
More investigations to consider
Treatment algorithm
ONGOING
all 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
Hobart W. Walling, MD, PhD
Dermatology Physician
Town Square Dermatology
Coralville
IA
Disclosures
HWW declares that he has no competing interests.
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
- Lichen simplex (syn. circumscribed neurodermatitis)
- 2016 European guideline for the management of vulval conditions
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