Lichen Simplex Chronicus

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ICD-9 Codes

698.3 – Lichenification and lichen simplex chronicus

Synopsis

Lichen simplex chronicus (LSC) is the cutaneous manifestation of chronic rubbing and/or scratching the skin from any source.

Clinically, lesions of LSC appear as well-defined plaques of lichenification and occasional scaling. Lichenification refers to thickened skin with enhanced skin markings as the result of friction from excessive scratching and rubbing. Individual papules may also be observed (prurigo nodularis), as may excoriations, which can become secondarily infected. As these lesions are self-induced, LSC is almost always distributed to areas of the body within hand's reach, most commonly on the back of the head and neck in women and in the genital (scrotum and perineum) area in men. LSC is more common in women and middle-aged-to-elderly patients.

The underlying precipitating factors inducing the patient to chronically scratch or rub their skin (causing lesions of LSC) are either known or unknown. LSC is commonly observed in uncontrolled atopic dermatitis and other dermatoses that have pruritus as a feature (eg, insect bites, scabies). When LSC is observed on relatively normal skin with no obvious underlying cutaneous (or systemic) precipitants, psychological factors are thought to play a significant role. In either case, an itch-scratch cycle is initiated, and if allowed to continue unabated, plaques of LSC inevitably develop.

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