Lichen simplex chronicus

Last reviewed: 30 Dec 2022
Last updated: 15 Oct 2019



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


all adults and children ≥12 years

children <12 years



Brian L. Swick, MD
Brian L. Swick

Clinical Professor

University of Iowa Departments of Dermatology and Pathology

Iowa City Veterans Affairs Medical Center

Iowa City



BLS declares that he has no competing interests.

Peer reviewers

Hobart W. Walling, MD, PhD

Dermatology Physician

Town Square Dermatology




HWW declares that he has no competing interests.

Helen Goodyear, MBChB, MRCP, FRCPCH, MD, MMed

Consultant Paediatrician

Heartlands Hospital




HG declares that she has no competing interests.

  • Lichen simplex chronicus images
  • Differentials

    • Hypertrophic lichen planus
    • Hypertrophic actinic keratoses
    • Squamous cell carcinoma of the skin
    More Differentials
  • Guidelines

    • Lichen simplex (syn. circumscribed neurodermatitis)
    • 2016 European guideline for the management of vulval conditions
    More Guidelines
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