Lichen Simplex Chronicus

This is a localized, itchy, well defined skin eruption. Lichen simplex chronicus usually starts with small papules that join together to become plaques. The skin thickens in response to rubbing and scratching (lichenification).

Increased skin markings often appear in a cross-hatch pattern. Nodules may sometimes occur as part of the thickening skin. The chronic itching and scratching causes skin to become thick and leathery, and turn a brownish color. The skin changes become cyclical, because as thickened skin itches, it causes more scratching, which in turn results in more thickening. Secondary infection of the skin is sometimes seen. Lichen simplex chronicus commonly occurs in association with eczema, psoriasis, and certain psychological disorders.

The exact cause is unknown, but affected individuals may be atopic (a genetic predisposition for developing certain hypersensitivity reactions). Once the itch-scratch cycle is established, it is very difficult to break this pattern without treatment.

Most often, lichen simplex chronicus is seen around the ankles, shins, forearms, and the back or sides of the neck. Involvement of anogenital regions, such as the vulva, scrotum and perianal areas are also possible. The resulting plaques can appear at single or multiple locations on the body.

In persistent lesions, a biopsy may be required to rule out any other skin disorder. Occasionally, patch testing may also be helpful.

Treatment

The aim of treatment is to stop the itch-scratch cycle. Potent topical steroids are usually required. Occlusion (a technique used to cover the skin with a film, i.e., Saran wrap, in order to improve penetration of topical corticosteroids) is sometimes necessary to try to reduce the itching and to thin out the excessively thickened skin.

The response to treatment may often take many weeks. Oral sedating antihistamines may be of benefit at bedtime. Secondary infections requiring topical or oral antibiotics may be required. The use of doxepin cream or capsaicin cream can sometimes help to reduce itching.

Incorporating emollient-based moisturizers and cleansers as part of routine skin care is essential for successfully managing eczema. A persistent feature of eczema is dry skin that is caused by a combination of genetic and environmental factors.

Some medical treatments for eczema can further worsen existing dryness, itching, and irritation. Ongoing treatment of the skin with moisturizers can repair the skin barrier by covering fissures and providing a protective film to reduce the penetrability of microbes, allergens and irritants, and inhibit water loss.

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