Lichen simplex chronicus

Lichen simplex chronicus is a benign skin condition associated with chronic pruritus and continual rubbing and/or scratching of the skin. It is most commonly seen in adults. Skin examination findings include thickened plaques and excoriations. Diagnosis is usually clinical. Without intervention, lichen simplex chronicus can persist indefinitely. Treatment is focused on identifying and managing any underlying causes of pruritus and preventing the continual rubbing and scratching.

• Most commonly affects adults ^[1][2]
• ♀ > ♂ ^[2]

Epidemiological data refers to the US, unless otherwise specified.

Lichen simplex chronicus results from a continual cycle of itching and scratching of the skin for relief. This may be caused by: ^[2][3]

• Habitual behavior (e.g., associated with psychiatric conditions and stress) ^[4][5]
• Chronic skin irritation and inflammation due to, e.g.: ^[1]
  • Atopic dermatitis
  • Contact dermatitis
  • Lichen sclerosus
  • Candidiasis

• Intense pruritus ^[1][3]
  • Rubbing and/or scratching the skin provides a sense of relief.
  • May impact sleep
• Lichenified plaques with excoriations ^[2][3]
• Lesions occur on any part of the body that can be scratched, including: ^[2]
  • Anogenital areas (e.g., vulva, scrotum, anus); see also “Vulvar dermatoses.”
  • Back of the neck (lichen simplex nuchae)
  • Scalp
  • Extremities

• Lichen simplex chronicus is primarily a clinical diagnosis. ^[3]
• Obtain further testing in cases of diagnostic uncertainty or to rule out alternative diagnoses, e.g.: ^[3]
  • Skin biopsy if malignancy is suspected
  • Fungal culture to exclude candidiasis as a cause of anogenital pruritus
• Skin biopsy findings include hyperplasia and hyperkeratosis of squamous epithelium. ^[6]

• Advise patients to avoid scratching and rubbing the skin, as this perpetuates symptoms. ^[1][3]
• Treat any underlying causes of pruritus, e.g.: ^[1][3]
  • Management of atopic dermatitis
  • Antifungal therapy for vulvovaginal candidiasis
  • Treatment of contact dermatitis
• Educate patients on nonpharmacological measures to reduce skin irritation and scratching, e.g.: ^[1][3]
  • Avoidance of chemical and mechanical skin irritants
  • Covering affected areas with occlusive dressings ^[2]
• Start pharmacological therapy to reduce inflammation and pruritus. ^[1][3]
  • Topical corticosteroids: The choice of agent depends on the location and severity of disease.
    • Medium potency agents (e.g., triamcinolone 0.1% ) ^[1]
    • High-potency agents (e.g., clobetasol ): may be used on the extremities or vulva for 2–4 weeks ^[1]
  • Oral agents for relief of pruritus, if needed
    • Hydroxyzine ^[1]
    • Amitriptyline ^[1]
  • Intralesional corticosteroids (e.g., triamcinolone): may be considered for small lesions ^[2]
• Arrange close follow-up (e.g., within 4 weeks). ^[3]
  • Tailor further management based on response to initial measures.
  • Consider specialist referral for severe or refractory cases; treatment options include: ^[3][4]
    • Systemic corticosteroids
    • Calcineurin inhibitors

Benign condition (risk of squamous cell carcinoma not increased)