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{{c1::Lichen simplex chronicus}} presents with well-defined plaques w/ lichenification, hyperpigmentation, and varying erythema that are solitary or multiple and usually on {{c2::posterior neck::location}} or {{c2::shins/ankles::location}} of older adults with xerosis, atopy, stasis, psychologic conditions, or pruritus secondary to systemic disease

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{{c1::<b>Lichen simplex chronicus</b>}} presents with well-defined plaques w/ <b>lichenification</b>, hyperpigmentation, and varying erythema that are solitary or multiple and usually on {{c2::<b>posterior neck</b>::location}} or {{c2::<b>shins/ankles</b>::location}} of older adults with xerosis, atopy, stasis, psychologic conditions, or pruritus secondary to systemic disease

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Other common locations: occipital scalp, anogenital skin, dorsal hands and feet, and forearms

Broader, thinner lesions than prurigo nodularis but w/ same itch-scratch cycle perpetuating the condition

Rx: treat underlying systemic or psychiatric illness if present; avoidance of scratching/rubbing; topical/IL agents (CS and calcineurin inhibitors); topical antipruritics (menthol and pramoxine), antihistamines, and behavioral therapy

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Other common locations: occipital scalp, anogenital skin, dorsal hands and feet, and forearms<br><br>Broader, thinner lesions than prurigo nodularis but w/ same <b>itch-scratch cycle</b> perpetuating the condition<br><br><u>Rx</u>: treat underlying systemic or psychiatric illness if present; <b>avoidance of scratching/rubbing</b>; topical/IL agents (CS and calcineurin inhibitors); topical antipruritics (menthol and pramoxine), antihistamines, and behavioral therapy

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Additional Causes of Pruritus - DermatoGraphix.com

Pruritus Ani

Sheep farm = Broad causes of pruritus
Itchy man in a diaper, holding 1 finger = Primary pruritus ani (no underlying cause)
Man sitting on a toilet = Secondary pruritus ani (irritants like stool/hemorrhoids)
Itchy wool sweater = Primary skin disorders causing pruritus ani
Sneezing into a tissue = Contact allergies
Germ on tissue = Infections
Radiation beam = Post-radiation therapy
Crab = Neoplasms as a secondary cause of pruritus ani

Lichen Simplex Chronicus (LSC)

Lichen tree = Lichen simplex chronicus (affects posterior neck/shins)
Scratching neck, wearing shin guards = Typical areas of LSC
Recycle sign = Repetitive itch-scratch cycle
Stop sign = Treatment focuses on stopping the scratching

Pruritus Scroti or Vulvae

Scrotum-shaped lichen tree = Pruritus scroti or vulvae, lichenification due to chronic scratching

Scalp Pruritus

Man with itchy head = Scalp pruritus
One finger up while scratching head = Primary scalp pruritus (emotional distress)
Two fingers up = Secondary scalp pruritus
Elbow and knee pads = Psoriasis
Red ball on beanie = Folliculitis
Flaky dandruff = Seborrheic dermatitis
Hydro-cooler = Topical steroids
Black tar = Tar shampoos
Sally on a cycle = Salicylic acid shampoos

Aquagenic Pruritus/Aquadynia

Tub of water = Aquagenic pruritus and aquadynia
Frog smiling in mirror = No visible skin changes
RBC-shaped lily pads = Polycythemia vera

Prurigo Nodularis

Prairie dog digging = Prurigo nodularis (dome-shaped nodules with central scale/erosion)
Dirt on arms = Common distribution on extensor extremities
Butterfly = Butterfly sign (mid-back spared from scratching)
Wildlife photographer = Phototherapy treatment
Grab a pint ice cream = Gabapentin/pregabalin
Tricycle = Tricyclic antidepressants
Duck with a pin = Doxepin
Dual pillow = Dupilumab
Coke SERO (middle-aged woman) = Selective serotonin reuptake inhibitors (SSRIs) and typical age of onset (middle-aged adults)

Drug-Induced Pruritus

Mu-ssage table = Opioids acting on mu receptors
Snorting cocaine = Cocaine
CiTy of LA Police Dept officer = CTLA-4 and PD-1 inhibitors
Raft = BRAF inhibitors
British Earl = EGFR inhibitors (ERLotinib)

VisualDx

<img src="http://127.0.0.1:63852/3335ef8671f9b6528abaf7cb568f2c4b.webp" style="max-width: var(--editor-default-max-width); max-height: var(--editor-default-max-height); width: unset; height: unset; font-family: Arial; font-size: 18px;"><br style="max-width: 100%; font-family: Arial; font-size: 18px;"><br><div style="max-width: 100%; font-family: Arial; font-size: 18px;"><div style="max-width: 100%;"><div style="max-width: 100%;"><div style="max-width: 100%;"><div style="max-width: 100%;"><div style="max-width: 100%;"><div style="max-width: 100%;"><div style="max-width: 100%;"><div style="max-width: 100%;"><div style="max-width: 100%;"><div style="max-width: 100%;"><div style="max-width: 100%;"><div style="max-width: 100%;"><div style="max-width: 100%;"><h3 style="max-width: 100%;">Additional Causes of Pruritus - DermatoGraphix.com</h3><div style="max-width: 100%;"><strong style="max-width: 100%;">Pruritus Ani</strong></div><ul style="max-width: 100%;"><li style="max-width: 100%;"><strong style="max-width: 100%;">Sheep farm</strong> = Broad causes of pruritus</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Itchy man in a diaper, holding 1 finger</strong> = Primary pruritus ani (no underlying cause)</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Man sitting on a toilet</strong> = Secondary pruritus ani (irritants like stool/hemorrhoids)</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Itchy wool sweater</strong> = Primary skin disorders causing pruritus ani</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Sneezing into a tissue</strong> = Contact allergies</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Germ on tissue</strong> = Infections</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Radiation beam</strong> = Post-radiation therapy</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Crab</strong> = Neoplasms as a secondary cause of pruritus ani</li></ul><div style="max-width: 100%;"><strong style="max-width: 100%;">Lichen Simplex Chronicus (LSC)</strong></div><ul style="max-width: 100%;"><li style="max-width: 100%;"><strong style="max-width: 100%;">Lichen tree</strong> = Lichen simplex chronicus (affects posterior neck/shins)</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Scratching neck, wearing shin guards</strong> = Typical areas of LSC</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Recycle sign</strong> = Repetitive itch-scratch cycle</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Stop sign</strong> = Treatment focuses on stopping the scratching</li></ul><div style="max-width: 100%;"><strong style="max-width: 100%;">Pruritus Scroti or Vulvae</strong></div><ul style="max-width: 100%;"><li style="max-width: 100%;"><strong style="max-width: 100%;">Scrotum-shaped lichen tree</strong> = Pruritus scroti or vulvae, lichenification due to chronic scratching</li></ul><div style="max-width: 100%;"><strong style="max-width: 100%;">Scalp Pruritus</strong></div><ul style="max-width: 100%;"><li style="max-width: 100%;"><strong style="max-width: 100%;">Man with itchy head</strong> = Scalp pruritus</li><li style="max-width: 100%;"><strong style="max-width: 100%;">One finger up while scratching head</strong> = Primary scalp pruritus (emotional distress)</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Two fingers up</strong> = Secondary scalp pruritus</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Elbow and knee pads</strong> = Psoriasis</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Red ball on beanie</strong> = Folliculitis</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Flaky dandruff</strong> = Seborrheic dermatitis</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Hydro-cooler</strong> = Topical steroids</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Black tar</strong> = Tar shampoos</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Sally on a cycle</strong> = Salicylic acid shampoos</li></ul><div style="max-width: 100%;"><strong style="max-width: 100%;">Aquagenic Pruritus/Aquadynia</strong></div><ul style="max-width: 100%;"><li style="max-width: 100%;"><strong style="max-width: 100%;">Tub of water</strong> = Aquagenic pruritus and aquadynia</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Frog smiling in mirror</strong> = No visible skin changes</li><li style="max-width: 100%;"><strong style="max-width: 100%;">RBC-shaped lily pads</strong> = Polycythemia vera</li></ul><div style="max-width: 100%;"><strong style="max-width: 100%;">Prurigo Nodularis</strong></div><ul style="max-width: 100%;"><li style="max-width: 100%;"><strong style="max-width: 100%;">Prairie dog digging</strong> = Prurigo nodularis (dome-shaped nodules with central scale/erosion)</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Dirt on arms</strong> = Common distribution on extensor extremities</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Butterfly</strong> = Butterfly sign (mid-back spared from scratching)</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Wildlife photographer</strong> = Phototherapy treatment</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Grab a pint ice cream</strong> = Gabapentin/pregabalin</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Tricycle</strong> = Tricyclic antidepressants</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Duck with a pin</strong> = Doxepin</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Dual pillow</strong> = Dupilumab</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Coke SERO (middle-aged woman)</strong> = Selective serotonin reuptake inhibitors (SSRIs) and typical age of onset (middle-aged adults)</li></ul><div style="max-width: 100%;"><strong style="max-width: 100%;">Drug-Induced Pruritus</strong></div><ul style="max-width: 100%;"><li style="max-width: 100%;"><strong style="max-width: 100%;">Mu-ssage table</strong> = Opioids acting on mu receptors</li><li style="max-width: 100%;"><strong style="max-width: 100%;">Snorting cocaine</strong> = Cocaine</li><li style="max-width: 100%;"><strong style="max-width: 100%;"><u style="max-width: 100%;">C</u>i<u style="max-width: 100%;">T</u>y of <u style="max-width: 100%;">LA</u> <u style="max-width: 100%;">P</u>olice <u style="max-width: 100%;">D</u>ept officer</strong> = CTLA-4 and PD-1 inhibitors </li><li style="max-width: 100%;"><strong style="max-width: 100%;">Raft</strong> = BRAF inhibitors </li><li style="max-width: 100%;"><strong style="max-width: 100%;">British <u style="max-width: 100%;">Earl</u></strong> = EGFR inhibitors (ERLotinib)</li></ul></div></div></div></div></div></div></div></div></div></div></div></div></div></div>

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