II. Epidemiology

  1. More common in Atopic Patients (Atopic Dermatitis)

III. Pathophysiology

  1. Response to chronic Atopic Dermatitis

IV. Symptoms

  1. Bouts of intense itching
    1. Rash does not appear until after scratching starts
    2. Rash may appear spontaneously
  2. Itching awakens person from sound sleep
    1. Scabies and Rhus Dermatitis prevent getting to sleep
  3. Associated with emotional stress or depressed mood

V. Signs

  1. Characteristics
    1. Red Papules and Plaques
    2. Overlying lichenification
  2. Sites of involvement
    1. Occiput and Neck (Lichen Simplex Nuchae)
      1. Usually occurs in women
    2. Outer lower portion of leg (more often in men)
    3. Ankle
    4. Wrists and extensor elbow
    5. Perineum and anus
    6. Scrotum or vulva
    7. Upper Eyelids and peri-auricle
    8. Scalp (Scalp-picker's Nodules)

VI. Differential Diagnosis

VII. Complications

VIII. Management

  1. See Pruritus Management
  2. Maximize management of Atopic Dermatitis
  3. Frequent application of Skin Lubricants
    1. Replaces the habit of scratching
  4. Bedtime Antihistamines
    1. Doxepin (Sinequan) 10 to 30 mg qhs
  5. Topical antipruritics
    1. Zonalon (topical Doxepin)
      1. Risk of drowsiness if widespread use
      2. Risk of contact allergy
    2. Menthol and Phenol (Sarna lotion)
    3. Pramoxine (PrameGel, Pramosone)
  6. Topical Corticosteroids
    1. For inflammatory rash
    2. Occlusion helpful for lichenified areas
  7. Intralesional steroids
    1. Consider in scalp-picker's Nodules
  8. Systemic Steroids
    1. Consider in severe refractory cases
    2. Prednisone 20 mg qd for 14 days
  9. Occlusion
    1. Medicated gauze bandages (Unna Boot)
    2. Dressing with impregnated steroid (Cordran Tape)

IX. References

  1. Habif (1996) Clinical Dermatology, Mosby, p. 69

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