Lichen Simplex Chronicus


Lichen Simplex Chronicus, Lichen Simplex, Circumscribed Neurodermatitis, Lichen Simplex Nuchae, Scalp Picker's Nodule, Vulvar Lichen Simplex Chronicus, Red Scrotum Syndrome

  • Pathophysiology
  1. Lichenified skin reaction to chronic scratching (may occur while asleep)
  • Causes
  1. Pruritic Conditions
    1. Atopic Dermatitis (most common)
    2. Candidiasis, Tinea Corporis or Tinea Cruris
    3. Psoriasis
    4. Scabies
    5. Skin cancers
  2. Exacerbating factors
    1. Heat or excessive sweating
    2. Irritation from overlying clothing
    3. Topical cleansers, lotions or other products
  • Signs
  1. Characterized
    1. Red Papules coalesce to form lichenified thick, scaly localized Plaque
    2. Hypopigmentation or Hyperpigmentation may occur
  2. Distribution
    1. Lateral calf (most common)
    2. Vulva (see Vulvar Pruritus)
    3. Scrotum (Red Scrotum Syndrome)
    4. Perianal area
    5. Wrists and ankles
    6. Upper Eyelids
    7. Posterior Neck (Lichen Simplex Nuchae from stress induced scratching)
    8. Ear canal
    9. Extensor elbow
    10. Behind ear
    11. Scalp Nodules (least common, Scalp Picker's Nodules)
  • Complications
  1. Impetigo or Cellulitis
    1. Typically dry Plaques become moist with scale, crusts and Pustules when infected
  • Management
  1. Treat underlying cause of Pruritus
  2. Treat superinfected areas (Impetigo or Cellulitis)
  3. Break the itch-scratch cycle
    1. See Pruritus Management
  4. Corticosteroids for specific locations
    1. Vulva
      1. Triamcinolone 0.1% ointment twice daily until active dermatitis resolves
      2. Advance to Clobetasol 0.05% daily if refractory after 2-3 weeks
      3. Consider oral Corticosteroids if still refractory after 2-3 weeks
    2. Intertriginous areas (perianal area or behind ear)
      1. Triamcinolone 0.1% ointment twice daily until active dermatitis resolves
    3. Scalp
      1. Fluocinonide gel applied twice daily until active lesions resolve
      2. Inject intralesional Corticosteroid (Kenalog 10 mg/ml) for scalp Nodules
      3. Consider Prednisone 20 mg twice daily for 2 weeks if severe inflammation