What Is Lichen Simplex Chronicus?
Lichen simplex chronicus, also known as scratch dermatitis, neurodermatitis, and neurodermatitis circumscripta, is a chronic form of dermatitis resulting from repeated skin scratching or rubbing. Scratching or rubbing causes more itching and further scratching or rubbing, which leads to a vicious itch-scratch cycle that results in the gradual thickening of the injured skin. The skin thickens in response to chronic physical skin injury and trauma (lichenification).
This condition starts with itchy skin, which leads to scratching and rubbing, which causes the skin to thicken, which often feels itchy, causing more scratching and skin thickening. Thickened skin can appear darker than the healthy, surrounding skin. This condition can occur anywhere on the body, though it usually occurs on accessible areas of skin, such as the head, neck, arms, hands, and genitals. If not treated by a dermatologist, this scratch-itch cycle can continue for years or indefinitely.
What Are The Clinical Features Of Lichen Simplex Chronicus?
Lichen simplex chronicus consists of one or more lichenified patches of skin or plaques. Skin with lichen simplex chronicus and the lichenification that results in an exaggeration of the normal skin marking creases, creating a criss-cross pattern on the skin. Other clinical features of lichen simplex chronicus may include the following features. This condition can present with one or more than one lesion, often occurring in areas that are easy to reach, such as the neck and scalp, vulva, pubis, scrotum, wrists, forearms, ankles, lateral shins, and thighs.
- Thickened areas of skin
- Broken hairs
What Causes Lichen Simplex Chronicus?
The exact cause of lichen simplex chronicus is unknown. Researchers point to certain emotional and environmental factors as potential lichen simplex chronicus causes. Additionally, psychological distress involved in psychological-related disorders like anxiety, depression, and obsessive-compulsive disorder may present physically as itchiness. A combination of certain psychological, emotional, and physical factors can perpetuate the itch-scratch cycle in people with lichen simplex chronicus.
Regarding potential environmental causes, factors such as excessive heat, sweating, and dry air can make the skin feel itchy. Some detergents, cleansers, and scented skin care products may also result in skin irritation. Lichen simplex chronicus is often a secondary condition to other primary skin disorders, such as psoriasis, atopic dermatitis, seborrheic dermatitis, and contact dermatitis, among other conditions.
Lichen Simplex Chronicus Risk Factors
Lichen simplex chronicus can occur in people of any age, race, sex, and stage of life. It is, however, more common in females than in males. It appears more frequently in people of middle age and in older adults than children, young adults, and adults. Certain conditions can result in the development of lichen simplex chronicus, including the following.
- Insect bites
- Insect stings
- Atopic Dermatitis (Eczema)
- Xerosis (Dry Skin)
- Venus Insufficiency (Poor Leg Circulation)
- Anxiety & Stress
How Is Lichen Simplex Chronicus Diagnosed?
Diagnosis of lichen simplex chronicus starts with a review of a patient’s medical and family history. A physical exam will allow the dermatologist to look closely at the affected area, which may prompt the clinician to recommend additional testing to rule out other possible skin conditions. A patch test may be performed to rule out an allergic reaction, which can present with similar skin inflammation but analyzing the skin’s reaction from contact with potential allergens.
In some cases, a skin biopsy may be performed to exclude the presence of other skin diseases, such as psoriasis, where skin cells grow and accumulate faster than normal; mycosis fungoides, a type of blood cancer; or squamous cell carcinoma, a type of skin cancer. The physician may recommend blood cultures to help rule out involvement with pathogens, such as fungi. For more information about the diagnosis process, please contact us.
How Is Lichen Simplex Chronicus Treated?
There are different ways to treat lichen simplex chronicus. One of the most important aspects of lichen simplex chronicus treatment is breaking the scratch-itch cycle. In addition to dermatologist-recommended self-care measures, your provider may recommend one or more treatments to reduce itching and scratching. The treatment of lichen simplex chronicus is typically centered around breaking the itch-scratch cycle, educating the patient, treating behavioral changes, pharmacotherapy, and applications and procedures.
- Extensive moisturizing techniques
- Corticosteroid creams or ointments
- Salicylic acid or urea topical treatments
- Oral antihistamines, particularly at bedtime
- Corticosteroid solution injections
- Ultraviolet (UV) light therapy
- Oral sedative medications
- Doxepin or capsaicin cream
- Topical or oral antibiotics
Complications Of Lichen Simplex Chronicus
Complications of lichen simplex chronicus may include the following. For additional information about this condition and possible complications, please contact Advanced Dermatology and Skin Cancer Center. Lichen simplex chronicus is not contagious. It is not caused by a pathogen, such as fungi, bacteria, and parasites, so it cannot be spread to another person.
- Hyper- or hypopigmentation
- Skin scarring
- Anxiety and other psychiatric-related conditions
- Adverse effects of medications used to treat the condition
Living With Lichen Simplex Chronicus
It can feel difficult and distressing to live with lichen simplex chronicus. However, many patients with this condition who seek clinical treatment from Advanced Dermatology and Skin Cancer Center can find relief through a unique combination of certain in-office therapies, behavioral changes, and at-home care. Your dermatologist will provide you with specific instructions for caring for your skin while at home. In general, however:
- Apply any recommended or prescribed medications exactly as directed
- If you experience an issue with your medication, contact your provider
- Take an over-the-counter antihistamine to help calm itching
- Wash the affected area with water only or using recommended products
- Apply a moisturizer after bathing while the skin is still damp
- Use dermatologist-recommended skin care products only
- Cover the affected area with a non-stick bandage for protection
- Apply a cold, wet cloth to the area to reduce itching
- Try to stay cool, as heat can exacerbate the itching
- Talk with your provider about any stress or anxiety