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Lichen simplex chronicus

Definition

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

Alternative Names

LSC; Neurodermatitis circumscripta; Eczema - lichen simplex chronicus; Atopic dermatitis - lichen simplex chronicus; Psoriasis - lichen simplex chronicus

Causes

LSC 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 also occurs in children who have chronic repetitive movements.

Symptoms

LSC leads to scratching, which then causes more itching. It often follows this pattern:

  • It may start when something 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, and this leads to more scratching. This then causes more thickening of the skin.
  • The skin may become leathery and brownish in the affected area.

Symptoms include:

  • Itching of the skin that may be long-term (chronic), intense, and that increases with stress
  • Leathery texture to skin
  • Raw areas of skin
  • Scaling
  • Skin lesion, patch, or plaque with sharp borders and a leathery texture, located on the ankle, wrist, neck, rectum, anal area, forearms, thighs, lower leg, back of the knee, and inner elbow

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 reduce the itch.

You may need to use these medicines on your skin:

  • Lotion or steroid cream on the area to calm itching and irritation
  • Numbing medicine
  • 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.

To control itching and stress you may need to take medicines by mouth, such as:

  • Antihistamines
  • Other oral medicines that control itch or pain

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

You may need to take antidepressants and tranquilizers if the cause of your itching is emotional. Other measures include:

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

Outlook (Prognosis)

You can control LSC by reducing itch and controlling scratching. The condition may return or move to different areas on the skin.

Possible Complications

These complications of LSC can occur:

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

When to Contact a Medical Professional

Call your provider if:

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

References

Habif TP. Eczema and hand dermatitis. In: Habif TP, ed. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 3.

Sommer LL, Millett CR, Baker DJ. Lichen simplex chronicus. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 131.

Review Date:10/24/2016
Reviewed By:David L. Swanson, MD, Vice Chair of Medical Dermatology, Associate Professor of Dermatology, Mayo Medical School, Scottsdale, AZ. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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