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Lichen nitidus on the abdomen
Lichen nitidus on the abdomen
Lichen simplex chronicus
Lichen simplex chronicus
Lichen simplex chronicus on the back
Lichen simplex chronicus on the back

Lichen simplex chronicus
Definition:
Lichen simplex chronicus is a skin disorder characterized by chronicitching and scratching. The persistent scratching causes formation of thick, leathery hyperpigmented skin.

Causes, incidence, and risk factors:

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

Lichen simplex chronicus may be a result of something (such as clothing) that rubs or scratches the skin, or irritation of the skin causing the person to rub or scratch an area. This causes thickening of the skin as a response to chronic irritation. The thickened skin itches, causing more scratching, causing more thickening. The skin may become leathery. The disorder may cause brownish pigmentation of the skin in the lesion 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 can be 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
  • Skin lesion, patch or plaque
    • Exaggerated skin lines over the lesion
    • Circumscribed lesion with distinct borders
    • Skin lesion becomes leathery textured (lichenification)
    • Darkened (hyperpigmented) or reddened skin
    • Excoriation, raw areas
    • Scratch marks
    • Scaling
    • 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 chronicitching 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 measures, or behavior modification.

The itching and inflammation may be treated with topical (applied to a localized area of the skin) steroid or antipruritic lotions. (See corticosteroids - topical - low potency, and corticosteroids - topical - medium to very high potency). Peeling ointments, such as those containing salicylic acid, may be used on thickened lesions. Soaps or lotions containing tars (coal tar) may be recommended.

Occlusive 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 with reduction of stress and scratching. It may recur or change sites.
Complications:
  • Secondary bacterial skin infection
  • Permanent scar formation
  • Permanent pigmentary changes
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.
Prevention:
.
Review Date: 8/6/2001
Reviewed By: Michael Lehrer, M.D., Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.
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