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Lichen simplex chronicus

Last reviewed: 3 Nov 2024
Last updated: 27 Mar 2024

Summary

Definition

History and exam

Key diagnostic 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
Full details

Risk factors

  • atopic diathesis
  • environmental irritants
  • psychiatric disorder
  • dermatologic disease
  • systemic conditions causing pruritus
Full details

Diagnostic tests

Tests 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
  • CBC
Full details

Treatment algorithm

ONGOING

adults and children ≥12 years

children <12 years

Contributors

Authors

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

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.

  • Lichen simplex chronicus images
  • Differentials

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

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