Lichen simplex chronicus

• Causes, incidence, and risk factors

  This disorder may occur with:

  • Eczema (atopic dermatitis)
  • Psoriasis
  • 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

  This skin disorder leads to a 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, which causes more thickening.
  • The skin may become leathery and brownish in the affected 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
    • Exaggerated skin lines over the lesion
    • Distinct borders to the lesion
    • Becomes leathery in texture (lichenification)
    • Darkened (hyperpigmented) or reddened skin
    • Raw areas
    • Scratch marks
    • Scaling
• 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 medication creams. They are left in place for a week or more at a time.

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

  Patients who have an emotional component to their lichen simplex chronicus may need antidepressants and tranquilizers.

• Expectations (prognosis)

  You can control lichen simplex chronicus by reducing stress and scratching less. The condition may return or change sites.

• Complications
  • Bacterial skin infection
  • Permanent changes in skin color
  • Permanent scar
• Calling your health care provider

  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 lesion, or fever

Review Date: 10/3/2008

Reviewed By: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.