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Lichen simplex chronicus in Adult
See also in: Anogenital
Other Resources UpToDate PubMed

Lichen simplex chronicus in Adult

See also in: Anogenital
Contributors: Susan Burgin MD, Noah Craft MD, PhD, Lowell A. Goldsmith MD, MPH
Other Resources UpToDate PubMed

Synopsis

Lichen simplex chronicus (LSC) is a lichenified well-demarcated scaly plaque that is induced by chronic rubbing and/or scratching. Lichenification refers to thickened skin with enhanced skin markings that occurs as a result of friction from excessive scratching and rubbing. Co-existing papules may also be observed (prurigo nodularis), as may excoriations, which can become secondarily infected. As these plaques are self-induced, LSC is almost always found on areas that are within hand's reach, most commonly on the back of the head and neck in women and in the genital (scrotum and perineum) area in men. The lower aspect of the lateral shin is another site that is frequently involved. LSC is more common in women and middle-aged to elderly patients.

Itch from a variety of causes induces individuals to chronically scratch or rub their skin. LSC is commonly observed in uncontrolled atopic dermatitis and other forms of eczema, and in other dermatoses that have pruritus as a feature (eg, insect bites, scabies). When LSC is observed on relatively normal skin with no obvious underlying cutaneous (or systemic) precipitants, psychological factors are thought to play a significant role. In either case, an itch-scratch cycle is initiated, and if allowed to continue unabated, plaques of LSC inevitably develop.

Codes

ICD10CM:
L28.0 – Lichen simplex chronicus

SNOMEDCT:
53891004 – Lichen simplex chronicus

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Psoriasis
  • Common wart
  • Atopic dermatitis
  • Acanthosis nigricans
  • Allergic contact dermatitis
  • Stasis dermatitis
  • Hypertrophic Lichen planus
  • Hypertrophic Discoid lupus erythematosus
  • Extramammary Paget disease
  • Acne keloidalis nuchae
  • Notalgia paresthetica – localized pruritic area at one side of the mid-scapula area
  • Squamous cell carcinoma in situ
  • Pretibial myxedema
  • Lichen amyloidosis
  • Cutaneous T-cell lymphoma

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated:06/15/2016
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Lichen simplex chronicus in Adult
See also in: Anogenital
A medical illustration showing key findings of Lichen simplex chronicus : Ankle, Eyelids, Lichenified plaque, Lower leg, Neck, Scrotum, Pruritus
Clinical image of Lichen simplex chronicus - imageId=3644043. Click to open in gallery.  caption: 'Lichenified, scaly, hyperpigmented plaques on the lateral foot and ankle.'
Lichenified, scaly, hyperpigmented plaques on the lateral foot and ankle.
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