Lichen Simplex Chronicus

A 41-year-old man sought treatment of the rough, intensely itchy patch on the dorsum of his left foot and lateral ankle. There were no other similar plaques on his body.

Drs Charles E. Crutchfield III and Humberto Gallego of St Paul, Minn, and Eric J. Lewis of Willmar, Minn, diagnosed lichen simplex chronicus-a common, extremely pruritic condition characterized by thickened plaques with accentuated skin markings. The usually idiopathic condition also may be associated with other cutaneous disorders, such as atopic dermatitis.

Intense itching is the primary manifestation-but not necessarily the chief complaint; many patients experience a pleasurable sensation from rubbing the area. In fact, the condition results from chronic rubbing and scratching. Commonly affected areas can be easily reached.

The primary goal of treatment is to break the itch/scratch cycle.

Patient education and application of a class II topical corticosteroid, preferably under occlusion, are recomended. Occlusion of the plaque enhances corticosteroid activity, places a protective barrier over the site, and reminds the patient not to rub or scratch.

Flurandrenolide tape, a corticosteroid preparation, was applied to this patient's lichen simplex chronicus. The tape was changed once daily for 3 weeks. Patient education was offered as well. The plaque cleared; however, recurrence is not uncommon in this disorder.