Information on Causes and Treatment of Lichen Simplex Chronicus

Lichen simplex chronicus describes thickened, discolored, leathery-looking skin that develops when the skin has been scratched or rubbed over a long period. It's not a disease but a symptom of prolonged scratching, rubbing, or abrasion.

Lichen simplex chronicus is often diagnosed when no other cause of the condition—other than scratching—is found. But, it can also develop secondary to chronic skin conditions like psoriasis or eczema. The neck, scalp, ankles, genitals, and forearms are most commonly affected.

The diagnosis is based on the examination of your skin and a review of your medical history. Treatment options include cotton gloves, moisturizers, or over-the-counter (OTC) antihistamines or steroid creams.

This article describes the symptoms, causes, diagnosis, and treatment of lichen simplex chronicus, including how emotional stress can contribute.

What Lichen Simplex Chronicus Looks Like

Itching and scratching are arguably the most prominent signs of lichen simplex chronicus. Chronic (ongoing) scratching can lead to changes in the appearance of the skin, called lichenification, in which tissues look like lichen that grows on trees and rocks.

Lichen simplex chronicus usually appears as a solitary patch with a round or oval shape. The skin will look dry and scaly with a thick, leathery texture and feel. The patch is often hyperpigmented (darker than the surrounding skin). There will often be visible scratch marks on or around the patch.

The areas most commonly affected sites include:

• Wrists
• Ankles
• The outer side of your calf
• Back and sides of your neck
• Forearm and elbow crease
• Genitals, mainly the scrotum and vulva
• Upper eyelids
• Opening of the ear
• Fold behind the ear

Over time, lichen simplex chronicus can lead to scarring and long-lasting or permanent changes in pigmentation.

There is also the risk of secondary bacterial infections, especially in people with low immune function. Severe cases can lead to an infection called cellulitis that affects deeper tissues or sepsis, a potentially deadly immune response to an infection that has spread into the bloodstream.

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What Triggers Lichen Simplex Chronicus?

Lichen simplex chronicus is a symptom rather than a disease. It is more common in adults and is fairly uncommon in children. It affects females more than males and is most often seen between the ages of 30 and 50.

Lichen simplex chronicus involves habitual scratching that can occur on its own or be secondary to a chronic skin disorder that causes pruritus (itching).

The cause may be psychosomatic or a "tic" that develops in response to anxiety, depression, or other mood disorders (like obsessive-compulsive disorder).

When it occurs secondary to another skin condition, the common suspects include:

• Eczema
• Contact dermatitis
• Psoriasis
• Fungal skin infections
• Scabies (a mite infestation)
• Dermatitis herpetiformis ("gluten rash")

Peripheral neuropathy, a nerve-related symptom that causes burning or tingling sensations, can also lead to chronic scratching. The causes of peripheral neuropathy are many, including diabetes, hypothyroidism, multiple sclerosis, alcoholism, and certain medications.

How Lichen Simplex Chronicus Is Diagnosed

The diagnosis of lichen simplex chronicus is based on an inspection of the skin. The primary aim of the diagnosis is to pinpoint the underlying cause. If no cause is found, lichen simplex chronicus may still be diagnosed and possibly attributed to anxiety or some other psychological cause.

In addition to a physical exam, your healthcare provider may ask questions to determine if you are experiencing high levels of stress or other emotional triggers that might account for the scratching.

They might also review the medications you take to see if any cause peripheral neuropathy (such as amiodarone or certain statin drugs).

Tests your provider may order include:

• KOH prep test to check for fungal infections
• Skin scrapings to look for evidence of scabies under the microscope
  
• Skin biopsy to check for psoriasis and other skin conditions in the lab
• Skin prick or patch testing to see if you check for common skin allergies
• Fasting plasma glucose to check for diabetes (the cause of diabetic neuropathy)
  

How Lichen Simplex Chronicus Is Treated

If lichen simplex chronicus is secondary to a chronic skin disorder, the treatment of the disease can often resolve the symptom.

Whether a cause is found or not, the healthcare provider may recommend the following self-care strategies to better manage your symptoms, including:

• Avoidance of scratching: This may include trimming your nails and wearing cotton gloves at night to avoid scratching in your sleep.
• Regular moisturizing: A fragrance-free emollient cream applied several times daily, especially after bathing, may reduce dryness and itching.
• Avoidance of tight clothing: Wear soft, loose clothing made of cotton that is less abrasive on the skin. This may not only aid with healing but also reduce the urge to scratch or rub the skin.
  
• Over-the-counter steroid creams: Products like Cortizone 10 (1% hydrocortisone cream) can help reduce skin inflammation and itching.
• Oral antihistamines: These allergy drugs may be appropriate if you experience nighttime scratching. Options include Benadryl (diphenhydramine) and Claritin (loratadine).

If scratching is thought to be due to anxiety or depression, antidepressant drugs like Sinequan (doxepin) may help ease symptoms.

Summary

Lichen simplex chronicus is a skin condition caused by scratching or rubbing that causes dark, leathery skin patches. The symptom may occur on its own or develop secondary to skin diseases like psoriasis or eczema. In some cases, the cause may be psychosomatic and due to underlying anxiety, stress, or depression.