A 30-year-old West African immigrant presented with white lines in his mouth and purple pruritic scaly papules and nodules on his body. The papules and nodules had appeared suddenly on his entire body but not on his face. Blood chemistry was normal. Rapid plasma reagin testing and a hepatitis panel showed no evidence of infection. Skin biopsy revealed a lichenoid infiltrate of lymphocytes and an interface dermatitis. The patient was in good overall health and was not taking any medications. No one else in his family had similar lesions.

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A 30-year-old Hispanic man complained of rashes on his lip and on his groin. Oral examination showed a jagged white line on his lips. He had similar single but jagged lines on his inner cheeks and some flattening of the tops of his teeth. Groin examination revealed areas of lichen simplex chronicus on his scrotum. A Tzanck smear of his lip did not demonstrate giant cells. The patient admitted to displacing nervous energy by washing his hands many times a day, biting his lips, and grinding his teeth. He had no medical problems and no family history of medical problems.