Lichen simplex chronicus

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Last reviewed: January 2019

Last updated: March 2018

Summary

May occur as a primary process with no underlying dermatosis or as a secondary process due to an underlying pruritic dermatosis (such as atopic dermatitis or allergic contact dermatitis) or a systemic condition causing pruritus.

Underlying psychological comorbidities may be present including depression, anxiety disorder, or obsessive-compulsive disorder.

A difficult to manage and often recurring condition that is treated with potent topical corticosteroids and sedating antihistamines.

Definition

Lichen simplex chronicus (LSC) is a common cutaneous disorder characterised by well-circumscribed erythematous, often hyperpigmented, patches and plaques of thickened lichenified skin most commonly occurring on the neck, ankles, scalp, pubis, vulva, scrotum, and extensor forearms, as a result of chronic rubbing and scratching. [1]

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

Full details

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

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Risk factors

atopic diathesis
environmental irritants
psychiatric disorder
dermatological disease
systemic conditions causing pruritus

Full details

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

Full details

Treatment algorithm

ONGOING

all adults and children ≥12 years

children <12 years

Contributors

Authors VIEW ALL 

Brian L. Swick, MD

Clinical Associate 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 VIEW ALL 

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.

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