Lichen simplex chronicus

Definition
Lichen simplex chronicus is a skin disorder characterized by chronic itching and scratching. The constant scratching causes thick, leathery, brownish skin.

Causes, incidence, and risk factors

This is a skin disorder characterized by a self-perpetuating scratch-itch cycle:

     
  • It may begin with something that rubs, irritates, or scratches the skin, such as clothing.  
  • This causes the person to rub or scratch the affected area. Constant scratching causes the skin to thicken.  
  • The thickened skin itches, causing more scratching, causing more thickening.  
  • The skin may become leathery and brownish in the affected area.

This disorder may be associated with atopic dermatitis (eczema) or psoriasis. It may also be associated with nervousness, anxiety, depression, and other psychologic disorders.

It is common in children, who chronically scratch insect bites and other areas. It can also be common in mentally retarded children who have chronic repetitive movements.

Symptoms

     
  • Itching of the skin       o May be chronic       o May be intense       o Increases with nervous tension, stress  
  • Skin lesion, patch, or plaque       o Exaggerated skin lines over the lesion       o Circumscribed lesion with distinct borders       o Skin lesion becomes leathery textured (lichenification)       o Darkened (hyperpigmented) or reddened skin       o Excoriation, raw areas       o Scratch marks       o Scaling       o Commonly located on the ankle, wrist, neck, rectum/anal area, forearms, thighs, lower leg, back of the knee, inner elbow

Signs and tests
The diagnosis is primarily based on the appearance of the skin and a history of chronic itching and scratching. A skin lesion biopsy may be needed to confirm the diagnosis.

Treatment

The primary treatment is to stop scratching the skin. This may include counseling to become aware of the importance of not scratching, stress management, or behavior modification.

The itching and inflammation may be treated with a lotion or steroid cream applied to the affected area of the skin. Peeling ointments, such as those containing salicylic acid, may be used on thickened lesions. Soaps or lotions containing coal tar may be recommended.

Dressings that cover and protect the area may be used with or without topical medications. They are left in place for a week or more at a time.

Antihistamines, sedatives, or tranquilizers may be needed to reduce itching and to reduce stress. Steroids may be injected directly into lesions to reduce itching and inflammation.

Antidepressants and tranquilizers may be needed in those patients who have an emotional component to their lichen simplex chronicus.

Expectations (prognosis)
Lichen simplex chronicus may be controlled by reducing stress and scratching. It may return or change sites.

Complications

     
  • Secondary bacterial skin infection  
  • Permanent scar formation  
  • Permanent changes in skin color

Calling your health care provider
Call your health care provider if symptoms worsen or new symptoms develop, especially signs of skin infection such as pain, redness or drainage from the lesion, or fever.

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, M.D.

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