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lichen simplex chronicus (LSC)
Form of lichenification generally occurring in localized plaques.
Etiology:
1) repeated scratching
2) emotional stress may be factor
a) skin is target of patient's anxiety
b) patients may have some insight into their disorder
Epidemiology:
1) adults > 20 years of age
2) more frequent in women than men
3) possibly higher incidence in Asians & native Americans
Pathology:
1) hyperplasia of all epidermal components
2) acanthosis
3) elongated & broadened rete ridges
4) spongiosis uncommon
5) chronic inflammatory infiltrate in dermis
Clinical manifestations:
1) solid plaques with minimal scaling & scarring
2) distribution: (areas easily reached by dominant hand)
a) nuchal area
b) scalp
c) lower extremities, especially lower legs & ankles
d) anogenital region
- case of vulvar pruritus without vaginal involvement [3]
- case with burning on urination [3]
- case with hyperpigmentation of labia majora & hypertrophy of labia minora [3]
e) upper trunk
3) lesions may last weeks to years
4) pruritus often paroxysmal
5) lichenified skin often becomes a pleasure to scratch
6) scratching becomes reflexive & habitual
7) itching may start from minor stimuli
8) skin becomes warmer in bed often precipitating itching
9) excoriations are frequently present
10) in blacks lichenification may consist of multiple 2-3 mm papules rather than plaques
11) generally dull red in color, later turning brown or black
12) difficulty falling asleep [3]
Laboratory:
- KOH preparation of skin scraping to rule out dermatophytes
- wet mount of vaginal secretion to exclude vulvovaginal candidiasis
- pH < 4.6
Differential diagnosis:
1) psoriasis vulgaris
2) early stages of mycosis fungoides
3) contact dermatitis
4) dermatophytosis
5) Schamberg's disease
Management:
1) occlusive bandages at night to prevent scratching & to facilitate penetration of topical steroids
a) cloth dressings
b) plastic dressing
1] hydrocolloid dressing
2] cordran tape (corticosteroids) impregnated in plastic tape
c) Unna boot
2) glucocorticoids
a) topical glucocorticoids covered by continuous dry occlusive gauze dressing
b) intralesional triamcinolone (3 mg/mL)
c) 5% crude coal tar in zinc oxide paste plus corticosteroids with occlusive cloth dry dressing
3) doxepin 5% ointment
Specific
vulvar lichen simplex chronicus; vulvar squamous cell hyperplasia; hyperplastic vulvar dystrophy
General
neurodermatitis
lichenification
chronic skin disease (chronic dermatologic disorder, chronic dermatopathy, chronic dermatosis)
References
- Saunders Manual of Medical Practice, Rakel (ed),
WB Saunders, Philadelphia, 1996, pg 924
- Color Atlas & Synopsis of Clinical Dermatology, Common
& Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY,
1997, pg 64-66
- Geriatric Review Syllabus, 7th edition
Parada JT et al (eds)
American Geriatrics Society, 2010
- Geriatric Review Syllabus, 11th edition (GRS11)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2022