A typical plaque stays localized and shows little tendency to enlarge with time. Lichen simplex is a chronic eczematous disease, but acute changes may result from sensitization with topical medication. Moist scale, serum, crust, and pustules are signs of Lichen simplex nuchae occurs almost exclusively in women who reach for the back of the neck during stressful situations. The disease may spread beyond the initial well-defined plaque. Diffuse dry or moist scale, crust, and erosions extend into the posterior scalp beyond the neck.
Secondary infection is common.
Nodules, usually less than 1 cm and scattered randomly in the scalp, occur in patients who frequently pick at the Treatment. The patient must first understand that the rash will not clear until even minor scratching and rubbing is stopped. Scratching frequently takes place during sleep, and the affected area may have to be covered.