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Lichen Simplex Chronicus

Lichen Simplex Chronicus is a topic covered in the 5-Minute Clinical Consult.

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  • Lichen simplex chronicus (LSC) is a chronic dermatitis resulting from chronic, repeated rubbing or scratching of the skin. Skin becomes thickened with accentuated lines (“lichenification”).
  • System(s) affected: skin
  • Synonym(s): LSC; lichen simplex; localized neurodermatitis; neurodermatitis circumscripta


Geriatric Considerations
Most common in middle aged and elderly

Pediatric Considerations
Rare in preadolescents

  • Common
  • Peak incidence 35 to 50 years
  • Predominant sex: females > males (2:1)


Etiology and Pathophysiology

  • Itch–scratch cycle leads to a chronic dermatosis. Repeated scratching or rubbing causes inflammation and pruritus, which leads to continued scratching.
  • Primary LSC: scratching secondary to nonorganic pruritus, habit or a conditioned response to stress/anxiety
  • Common triggers are excess dryness of skin, heat, sweat, and psychological stress.
  • Secondary LSC: begins as a pruritic skin disease that evolves into neurodermatitis, which persists after resolution of the primary condition. Precursor dermatoses include atopic dermatitis, contact dermatitis, lichen planus, stasis dermatitis, psoriasis, tinea, and insect bites.
  • There is a possible relation between disease development and underlying neuropathy, particularly radiculopathy or nerve root compression.
  • Pruritus-specific C neurons are temperature sensitive, which may explain itching that occurs in warm environments.

Risk Factors

  • Anxiety disorders
  • Dry skin
  • Insect bites
  • Pruritic dermatosis

General Prevention

Avoid common triggers such as psychological distress, environmental factors such as heat and excessive dryness, skin irritation, and the development of pruritic dermatoses.

Commonly Associated Conditions

  • Prurigo nodularis is a nodular variety of the same disease process.
  • Atopic dermatitis
  • Anxiety, depression, and obsessive-compulsive disorders

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Stephens, Mark B., et al., editors. "Lichen Simplex Chronicus." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116352/all/Lichen_Simplex_Chronicus.
Lichen Simplex Chronicus. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116352/all/Lichen_Simplex_Chronicus. Accessed April 25, 2019.
Lichen Simplex Chronicus. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116352/all/Lichen_Simplex_Chronicus
Lichen Simplex Chronicus [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 25]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116352/all/Lichen_Simplex_Chronicus.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Lichen Simplex Chronicus ID - 116352 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116352/all/Lichen_Simplex_Chronicus PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -