lichen simplex chronicus

Diagnosis: lichen simplex chronicus

well circumscribed patch of intensely itchy lichenification with scaling and hyperpigmentation.at the right leg(lateral aspect).

Clinical Presentation

well circumscribed patch of intensely itchy lichenification with scaling and hyperpigmentation.at the right leg(lateral aspect).

Clinical History

Submitted by sameh elseiny. Originally posted March 26, 2011.

Treatment

See case discussion.

Differential Diagnosis

• Psoriasis • Atopic dermatitis • Mycosis fungoides • Hypertrophic lichen planus • Prurigo nodularis • Contact dermatitis • Nummular eczema

Key Learnings

• The end-stage of the itch-scratch cycle — chronic rubbing/scratching leads to lichenification • Lichenification: thickened skin with exaggerated skin markings • Common sites: posterior neck (lichen nuchae), ankles, wrists, vulva/scrotum • NOT a primary dermatosis — secondary to chronic scratching • Underlying cause of pruritus should be investigated • May overlie an existing dermatosis (eczema, psoriasis) or be primary (psychogenic) • Histology: irregular acanthosis, hypergranulosis, hyperkeratosis, vertical orientation of collagen in papillary dermis

Tags: lichen, simplex, chronicus, sameh elseiny