Lichen simplex chronicus

Definition

Lichen simplex chronicus is a skin condition caused by chronic itching and scratching.

Causes

This disorder may occur in people who have:

• Skin allergies
• Eczema (atopic dermatitis)
• Psoriasis
• Nervousness, anxiety, depression, and other emotional problems

The problem is common in children, who cannot stop scratching insect bites and other itchy skin conditions. It is also found in children who have chronic repetitive movements.

Symptoms

This skin disorder leads to scratching which in turn causes more itching.

• It may start when something that rubs, irritates, or scratches the skin, such as clothing.
• The person begins to rub or scratch the itchy area. Constant scratching causes the skin to thicken.
• The thickened skin itches, causing more scratching, which causes more thickening.
• The skin may become leathery and brownish in the problem area.

Symptoms include:

• Itching of the skin
  • May be long-term (chronic)
  • May be intense
  • Increases with nervous tension, stress
• Skin lesion, patch, or plaque
  • Commonly located on the ankle, wrist, neck, rectum/anal area, forearms, thighs, lower leg, back of the knee, inner elbow
  • Deep skin lines over the problem area
  • Sharp borders to the itchy area
  • Leathery texture (lichenification)
  • Darker (hyperpigmented) or red skin
  • Raw areas
  • Scratch marks
  • Scaling

Exams and Tests

Your health care provider will look at your skin and ask if you have had chronic itching and scratching in the past. A skin lesion biopsy may be done to confirm the diagnosis.

Treatment

The main treatment is to stop scratching the skin. You may have:

• Counseling to help you realize of the importance of not scratching
• Stress management
• Behavior modification.

You may need to use the following medicines on your skin:

• Lotion or steroid cream on the area to calm itching and irritation
• Peeling ointments containing salicylic acid on patches of thick skin
•  Soaps or lotions containing coal tar

You many need to use dressings that moisturize, cover, and protect the area. These may be used with or without medicated creams. They are left in place for a week or more at a time.

You may need take medicines by mouth to control itching and stress such as:

• Antihistamines
• Sedatives
• Tranquilizers  

Steroids may be injected directly into the skin patches areas to reduce itching and irritation.

You may need to take antidepressants and tranquilizers to treat emotional causes for the problem.

Outlook (Prognosis)

You can control lichen simplex chronicus by taking steps to control scratching and reduce stress. The condition may return or move to different areas on the skin.

Possible Complications

• Bacterial skin infection
• Permanent changes in skin color
• Permanent scar

When to Contact a Medical Professional

Call your health care provider if:

• Symptoms get worse
• You develop new symptoms, especially signs of skin infection such as pain, redness or drainage from the area, or fever

References

Habif TP. Ezcema and hand dermatitis. In: Habif TP, ed. Clinical Dermatology. 5th ed. St. Louis, Mo: Mosby Elsevier; 2009:chap 3.

Bolognia JL, Jorizzo JL, Schaffer JV, et al, eds.Dermatology. 3rd ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap 6.

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