Lichen Simplex Chronicus: Everything You Need to Know

What Is Lichen Simplex Chronicus?

LSC is a condition in which the skin becomes thicker and scaly because of repeated scratching or rubbing. You may also hear it called neurodermatitis. It usually affects only one or two patches of skin.

The thickening, known as lichenification, is not where the problem begins. It starts with an itch in one spot, which may or may not come from an underlying skin disease. Scratching that spot over and over injures the skin, and the skin responds by growing tougher and thicker.

A Cycle of Itching and Scratching

Once it takes hold, the itch keeps returning and scratching becomes automatic, often without the person noticing. The itch tends to be most active at night, while trying to fall asleep or during sleep, and many people rub the area as soon as they wake up. For some, scratching only aggravates the irritation, which leads to even more scratching.

Where It Appears

LSC usually shows up in places that are easy to reach, such as:

• The scalp, head and back of the neck
• The arms, shoulders and elbows
• The wrists and hands
• The thighs and ankles
• The genital area

Symptoms of Lichen Simplex Chronicus

LSC appears as dry, scaly patches whose size depends on how much skin has been damaged by scratching. Because the body builds tougher skin to protect itself from constant rubbing, the affected patches become:

• Thick and leathery
• Dry and scaly
• Marked by deeper, more noticeable skin creases
• Different in color from the surrounding skin, appearing reddish, brownish, yellowish, gray or purple

Older patches may have a lighter or white center with darker skin around it. Heavy scaling can make the itch feel unbearable, and repeated scratching can cause the skin to bleed. Scarring may develop over time.

What Causes Lichen Simplex Chronicus?

The exact cause is not known. Current findings suggest that emotional and environmental factors both play a part, and that the two often work together to keep the itch-scratch cycle going.

Stress and Emotional Factors

Stress, worry, emotional trauma and grief have all been linked to itching, though it is not clear why. The itch can last for hours even after the stressful moment has passed. LSC has also been associated with:

• Anxiety disorders
• Depression
• Obsessive-compulsive disorder

Some studies suggest that scratching can act as a mental distraction. That mix of emotional and physical factors may help explain why the cycle is so hard to break.

Skin and Environmental Triggers

Many things that irritate the skin can set off the itch, including:

• Hot weather and sweating
• Dry air and dehydrated skin
• Detergents and scented products
• Insect bites
• Tight clothing made from synthetic fabrics such as polyester or rayon
• Nerve injury
• Other skin conditions, including atopic dermatitis (eczema) and psoriasis

Because several conditions can cause similar patches, a dermatologist should make the diagnosis rather than leaving it to guesswork.

Who Gets Lichen Simplex Chronicus?

LSC is most often diagnosed in adults between the ages of 30 and 50, and it is more common in women. People with atopic dermatitis or contact dermatitis, people with anxiety or obsessive-compulsive behavior, and people with a family history of skin conditions such as contact dermatitis are also at higher risk. It is uncommon in children, although it can occur in some children who already have atopic dermatitis.

LSC is not contagious. It is not caused by fungi, bacteria, parasites or any other germ, so it cannot be passed from one person to another.

How Lichen Simplex Chronicus Is Diagnosed

A dermatologist will examine the affected skin closely and ask about your medical history and your family's history. Part of the process is ruling out other conditions that can look similar, such as eczema or psoriasis. Depending on what the exam shows, your dermatologist may recommend:

• A patch test, which checks how your skin reacts to possible allergens, to find out whether an allergy is behind the itch
• A skin swab to check for infection
• Tests for a fungal infection
• A skin biopsy, in some cases, to rule out other skin conditions

How Lichen Simplex Chronicus Is Treated

Treatment focuses on relieving the itch, breaking the itch-scratch cycle and helping the skin return to normal. Left untreated, LSC seldom improves, so it is worth getting care. Your dermatologist may recommend one or more of the following.

Calming Itch and Inflammation

Topical steroids, also called corticosteroids, can ease itching, inflammation and thickened skin. Very thick patches may need steroid injections. Topical salicylic acid can help with thickened skin, and numbing creams or creams made with chili pepper extract are other options for irritated nerves. An oral medication taken at night may also help relieve itching.

Treating Infection and Allergy Triggers

If the area has become infected, your dermatologist may recommend antibiotic treatment. When the inflammation looks like an allergic reaction to something in your environment, an antihistamine may help control it, along with steps to limit your contact with that allergen.

Managing Stress and the Urge to Scratch

Because LSC is so closely tied to emotional health, addressing stress can be an important part of treatment. Talking with a mental health professional may help with the emotional strain that keeps the itch going, and a low-dose anti-anxiety medication is sometimes prescribed when it is needed. Yoga and mindfulness practices such as meditation can also help reduce scratching.

When to See a Dermatologist

Make an appointment with a dermatologist if:

• You find yourself scratching or rubbing the same patch of skin over and over
• Itching keeps you from sleeping or concentrating on everyday tasks
• Your symptoms get worse or new symptoms appear
• You notice signs of a skin infection, such as pain, redness, discharge from the area or fever

Related reading

• Eczema treatment at Team Dermatology
• What Causes Eczema to Flare Up?
• What's the Difference Between Eczema and Psoriasis?
• Rash treatment at Team Dermatology

If a patch of itchy, thickened skin keeps drawing you back to scratch it, request an appointment with one of our dermatologists at our Houston-area clinics. Team Dermatology can confirm what is going on and help you find a way out of the itch-scratch cycle.