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.
Lichen simplex chronicus (LSC) is a common cutaneous disorder characterized by well-circumscribed erythematous, often hyperpigmented, patches and plaques of thickened lichenified skin. It most commonly occurrs on the neck, ankles, scalp, pubis, vulva, scrotum, and extensor forearms as a result of chronic rubbing and scratching.
History and exam
Key diagnostic factors
- underlying dermatosis
- pruritus beginning during psychological stress
- severe intractable itching
- erythematous to violaceous plaques
- lesions on neck, ankles, scalp, vulva, scrotum, pubis, and extensor forearms
Other diagnostic factors
- altered pigmentation
- linear fissures
- grouped hyperpigmented papules on the shins
- hyperpigmented patch on the interscapular back
- underlying psychiatric disorder
- underlying systemic condition causing pruritus
- atopic diathesis
- environmental irritants
- psychiatric disorder
- dermatologic disease
- systemic conditions causing pruritus
Investigations 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
Brian L. Swick, MD
University of Iowa Departments of Dermatology and Pathology
Iowa City Veterans Affairs Medical Center
BLS declares that he has no competing interests.
Hobart W. Walling, MD, PhD
Town Square Dermatology
HWW declares that he has no competing interests.
Helen Goodyear, MBChB, MRCP, FRCPCH, MD, MMed
HG declares that she has no competing interests.
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