Lichen Simplex

Lichen simplex is used to describe the skin changes seen secondary to scratching or rubbing in response to the symptom of itch. The itch may be because of a low-grade dermatitis such as psoriasis or seborrheic eczema but often is a sensory abnormality alone. The lesions of lichen simplex tend to be in one isolated area, usually on the labia majora or mons pubis. The change is characterized by a well-defined pale gray or white surface with an accentuation of the normal rhomboidal markings. The his-tological changes of lichen simplex include hyperkeratosis, acanthosis, a prominent granular layer, and lengthened rete ridges (Fig. 24).

Treatment: The treatment is the nightly application of a potent topical steroid to try and break the itch scratch cycle. A soap substitute should be introduced and possible irritants avoided. If the problem continues despite these measures, patch testing should be performed to exclude the possibility of an unsuspected allergen (Table 12).

Protruding Mons Pubis Pictures
Figure 27 (A) Melanosis. Multiple pigmented areas are seen. (B) Melanosis (lentigo)—there are increased numbers of melanocytes and an increase in the amount of melanin.
Table 14 Vulvar Melanosis



Clinical appearance

Differential diagnosis


Vulvar melanosis


Brown, gray,


None, but





following lichen



planus, VIN

Abbreviation: VIN, vulvar intra-epithelial neoplasia.

Abbreviation: VIN, vulvar intra-epithelial neoplasia.

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