Case Study : Dermatology
57. Lichen Chronicus Simplex
57. Itchy rash on neck
A 32-year-old woman presented to her family physician (FP) with an itchy red rash that had developed on the back of her neck 6 months earlier.
She said that the rash itched all day long and she found herself scratching it frequently.
She also said that for the past 10 years, she’d had a brown rash around her neck.
The patient reported that diabetes ran in her family and said she knew she needed to lose weight. She was screened for diabetes a year earlier, and her glucose and glycosylated hemoglobin were normal.
Diagnosis: Lichen Chronicus Simplex
The FP diagnosed lichen simplex chronicus (LSC) in this patient, based on the lesion’s clinical appearance and location, as well as the patient’s history of repeated daily scratching.
LSC is more common in women than in men, and occurs mostly in mid- to late-adulthood, with the highest prevalence in people who are 30 to 50 years of age.
A very common location for LSC in women is the back of the neck. In this case the LSC was coexisting with acanthosis nigricans.
Fortunately, this patient did not have diabetes, but her obesity and family history predisposed her to acanthosis nigricans.
The treatment for LSC is topical mid- to high-potency corticosteroids.
Oral sedating antihistamines can be added at night if pruritus is bad during the evening.
If the patient acknowledges that stress is involved, obtain a good psychosocial history and offer the patient treatment for any problems you uncover.
Patients need to minimize touching, scratching, and rubbing of the affected areas.
Explain to patients that they are unintentionally hurting their own skin.
Suggest that they gently apply their medication or a moisturizer instead of scratching the pruritic areas.
In this case, the FP prescribed topical triamcinolone ointment and stressed the importance of not rubbing or scratching the area.
The patient’s LSC healed well.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R, Johnson A. Self-inflicted dermatoses. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013: 856-862.
Topical triamcinolone ointment is not available in Ireland.
Alternate steroid ointment applied OD or BD may be used.
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