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Lichen Simplex Chronicus — SCE Dermatology MCQ

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HardInflammatory DermatosesLichen Simplex ChronicusSCE Dermatology

A lichenified plaque on the nape has persisted despite regular emollient. Mycology is negative and there is no clinical evidence of infection. Which treatment is most likely to interrupt the established itch-scratch cycle?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Potent topical corticosteroid with suitable occlusion and trigger control

Explanation lettering: D = shown as A · E = shown as B · B = shown as C · A = shown as D · C = shown as E

E is correct. Lichen simplex is sustained by repeated rubbing and scratching, so management combines identification of the initiating itch, behavioural or physical measures to stop manipulation and sufficiently potent topical anti-inflammatory treatment. A short course of a potent topical corticosteroid is commonly used on appropriately selected sites; occlusion can enhance effect and prevent access but requires careful instruction. Negative mycology and absent infection argue against antifungal or antibiotic therapy. Lichenification is reactive acanthosis and hyperkeratosis, not an indication for excision. Potency, duration and review should reflect site, skin thickness and adverse-effect risk.

Reference: BAD lichen simplex information: https://www.bad.org.uk/pils/lichen-simplex