Lichen simplex chronicus may represent the end stage of a variety of pruritic and eczematous disorders. It consists of a well-circumscribed plaque or plaques with lichenified or thickened skin due to chronic scratching or rubbing. Common areas involved include the posterior nuchal region, dorsum of the feet, or ankles.
Treatment of lichen simplex chronicus centers around breaking the cycle of chronic itching and scratching, which often occur during sleep. High-potency topical glucocorticoids are helpful in alleviating pruritus in most cases, but in recalcitrant cases, application of topical glucocorticoids under occlusion or intralesional injection of glucocorticoids may be required. Oral antihistamines such as hydroxyzine (10 to 50 mg every 6 h) or tricyclic antidepressants with antihistaminic activity such as doxepin (10 to 25 mg at bedtime) are useful as antipruritics primarily due to their sedating action, and are particularly useful at bedtime.
Patients need to be counseled regarding driving or operating heavy equipment after taking these medications due to their potentially potent sedative activity.
Violaceous or purplish, solid, fiem papules, resembling lichen planus but not due to it. This term is loosely used till a proper diagnosis is established. Similarly terms like pemphigoid, leucodermoid and psoriasiform have been coined to describe cutaneous lesions morphologically.
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