The physician diagnosed lichen simplex chronicus (LSC). LSC is more common in females than in males, with the highest prevalence in individuals between the ages of 30 and 50 years.
The treatment for LSC is mid- to high-potency topical corticosteroids. If pruritus is bad at night, oral sedating antihistamines can be added in the evening. If the patient acknowledges that stress is a factor, obtain a psychosocial history and offer the patient treatment for any problems uncovered.
Patients need to minimize touching, scratching, and rubbing of the affected areas. It’s important to help patients understand that they are unintentionally hurting their own skin. Suggest that patients gently apply their medication or a moisturizer instead of scratching the pruritic areas. Also advise patients that post-inflammatory hyperpigmentation can take months to resolve and may not resolve fully.
The patient in this case was treated with topical clobetasol ointment and received patient education; her LSC healed well.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Self-inflicted dermatoses. In: Usatine R, Smith M, Mayeaux EJ, Chumley H, Tysinger J, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:603-608.
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