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

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  1. See Also
    1. Neurodermatitis
    2. Atopic Dermatitis
    3. Pruritus
    4. Vulvar Pruritus
  2. Pathophysiology
    1. Lichenified skin reaction to chronic scratching (may occur while asleep)
  3. 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
  4. 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)
  5. Complications
    1. Impetigo or Cellulitis
      1. Typically dry Plaques become moist with scale, crusts and Pustules when infected
  6. 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
  7. References
    1. Lotti (2008) Dermatol Ther 21:42
    2. Virgili (2001) J Reprod Med 46:343

Lichen Simplex Chronicus (C0149922)

ConceptsDisease or Syndrome (T047)
ICD9698.3
MSHD009450
EnglishCircumscribed Neurodermatitides, Circumscribed Neurodermatitis, Lichen simplex, Lichen Simplex Chronicus, LICHEN SIMPLEX CIRCUMSCRIPTUS, Lichenified eczema, Lichenified eczematous dermatitis, Local neurodermatitis, Localized Neurodermatitides, Localized Neurodermatitis, LSC - Lichen simplex chronicus, Neurodermatitis circumscripta
Spanishdermatitis eccematosa liquenificada, eccema liquenificado, eczema liquenificado, liquen simple cronico, neurodermatitis circunscripta, neurodermatitis local
Parent ConceptsEczema (C0013595), Lichen disease (C0023643), Duplicate concept (C1274013)
SourcesCOSTAR, DXP, MSH, MTHICD9, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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