Lichen Simplex Chronicus

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Lichen simplex chronicus (LSC) is a secondary condition that results from repeated mechanical trauma to the skin, usually through rubbing and scratching, which causes lichenification (thickening of epidermis). Skin appears leathery, violaceous to hyperpigmented, and scaly (Fig. 33-29). Involved areas are within the patient's easy reach, such as arms, legs, posterior neck, upper back, buttocks, and scrotum. The cycle of pruritus, which is alleviated by scratching, perpetuates the condition. Pruritus is usually worse during periods of inactivity, usually at bedtime and during the night. Stress also may provoke pruritus, which

Figure 33-29 Lichen simplex chronicus. (e Richard P. Usatine.)

is relieved by rubbing and scratching and often becomes an unconscious behavior.

Treatment of LSC is aimed at treating existing lesions, reducing pruritus, providing insight into the itch-scratch cycle, and eliciting behavioral changes, Topical steroids decrease inflammation and pruritus and help "thin down" the hyperkeratosis. Because lesions are by nature chronic, long-term treatment should be stressed. Occlusion can be used to increase potency and enhance delivery of the topical steroid and also provides a barrier to scratching. Fluran-drenolide tape (Cordran) is very effective and can be cut to fit each lesion of LSC. Anxiolytics and antihistamines such as diphenhydramine and hydroxyzine may be considered as adjunct treatments. In severe, debilitating cases, oral doxepin and clonazepam may be considered. For secondary infections, a topical or oral antibiotic is appropriate.

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