History
Patients with lichen simplex chronicus usually describe stable pruritic plaques on one or more areas; however, thickening of the skin occurs on any location that the patient can reach, including the following:
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Scalp [16]
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Nape of neck
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Extensor forearms and elbows
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Upper medial thighs, knees, lower legs, and ankles
Erythema is noted most in early lesions.
Pruritus is described as worse when patients are still or quiet and as much less or nonexistent when patients are active.
Pruritus is usually intermittent; the resultant scratching provides temporary relief.
Patients may have a past medical history of a chronic skin condition or acute trauma. Patients with atopic dermatitis may have lichen simplex chronicus in areas of former atopic outbreaks. Sites of irritant or allergic contact dermatitis, insect bites, or other past minor skin trauma sometimes demonstrate pruritus and, subsequently, lichen simplex chronicus.
Physical Examination
One or more slightly erythematous, scaly, well-demarcated, lichenified, firm, rough plaques with exaggerated skin lines are noted.
Each palm-sized plaque may have 3 zones. A 2- to 3-cm wide peripheral zone that is barely thickened may have isolated papules. The middle zone has lenticular and hemispheric prurigo papules that may be excoriated. The central zone has the greatest thickening and pigmentary alteration.
Pigmentary changes (especially hyperpigmentation) are seen variably as in any dermatitic lesion.
Rubbing plays a key role in lesion formation and is visualized variably by white scratch marks, erosion, and ulceration from deeper scratching.
Lichen simplex chronicus is one of the hyperkeratotic processes from which a cutaneous horn may grow. [21]
Patients may scratch lesions de novo when observed. Some patients may start scratching while discussing the itch or describing the lesions.
Note the images below.
Lichen simplex chronicus of the dorsal hand and wrist demonstrating increased skin thickness and accentuation of skin markings.
Plaque of lichen simplex chronicus of the leg with accentuated skin markings and excoriations.
Plaque of lichen simplex chronicus demonstrating accentuated skin markings. Courtesy of San Antonio Uniformed Services Health Education Consortium Dermatology Program.
Area of lichen simplex chronicus originally believed to be chronic contact dermatitis. The true nature was revealed when the patient admitted to rubbing this area while watching television. Courtesy of San Antonio Uniformed Services Health Education Consortium Dermatology Program.
Complications
Patients with lichen simplex chronicus have higher rates of diabetes mellitus, hyperlipidemia, hypertension, coronary artery disease, peripheral vascular disease, chronic obstructive pulmonary disease, and chronic kidney disease. [6]
Patients with lichen simplex chronicus are more likely to develop erectile dysfunction than age-matched controls. Physicians should be aware of the association between lichen simplex chronicus and erectile dysfunction and advise or arrange timely sexual consultations. [6]
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Plaque of lichen simplex chronicus demonstrating accentuated skin markings. Courtesy of San Antonio Uniformed Services Health Education Consortium Dermatology Program.
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Area of lichen simplex chronicus originally believed to be chronic contact dermatitis. The true nature was revealed when the patient admitted to rubbing this area while watching television. Courtesy of San Antonio Uniformed Services Health Education Consortium Dermatology Program.
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Plaques of lichen simplex chronicus on the hand.
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Lichen simplex chronicus of the dorsal hand and wrist demonstrating increased skin thickness and accentuation of skin markings.
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Plaque of lichen simplex chronicus of the leg with accentuated skin markings and excoriations.
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H and E biopsy of lichen simplex chronicus from forearm skin viewed at 40x magnification. Note the characteristic hyperkeratosis, hypergranulosis, pseudoepitheliomatous hyperplasia, and papillary dermal fibrosis.
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H and E biopsy of lichen simplex chronicus from forearm skin viewed at 100x magnification. Note the characteristic hyperkeratosis, hypergranulosis, pseudoepitheliomatous hyperplasia, and papillary dermal fibrosis.
