Lichen Simplex Chronicus - Causes, Symptoms and Treatment

Definition

Lichen simplex chronicus is also known as neurodermatitis. It thickening of the skin with variable scaling that arises secondary to repetitive scratching or rubbing. Lichen simplex chronicus is not a primary process. Rather, a person senses pruritus in a specific area of skin and causes mechanical trauma to the point of lichenification. The constant scratching causes thick, leathery, brownish skin. It is not serious but breaking the itch-scratch cycle can be challenging. Successful treatment depends on identifying and eliminating factors that may be aggravating the problem. Over-the-counter and prescription creams can help. It is seen in people with eczema. Although eczema can affect the whole body, the eruption of LSC in usually found in one area. It occurs mostly in mid-to-late adulthood, with highest prevalence in persons aged 30-50 years. It is observed more commonly in females than in males. Lichen nuchae is a form of lichen simplex that occurs on the midposterior neck and is observed almost exclusively in women.

Causes

1. The exact cause is unknown.
2. Some skin types are more prone to lichenification, such as skin that tends toward eczematous conditions i.e. atopic dermatitis, atopic diathesis etc.
3. Lichen simplex chronicus begins with something that simply rubs or irritates the skin, such as tight clothing or a bug bite.
4. Persistent rubbing causes the epidermis to thicken. Secondary infection of the skin is sometimes seen.
5. The possibility of infection is greatly increased when the outer layer of protective skin is broken.

Symptoms

1. There may be itching in the skin. The Itching may be chronic and intense. The itching may Increases with nervous tension or mental stress.
2. It is observed more commonly in females than in males. Lichen nuchae is a form of lichen simplex is observed almost exclusively in women.
3. It occurs mostly in mid-to-late adulthood, with highest prevalence in persons aged 30-50 years.
4. Patients may have a past medical history of a chronic skin condition or acute trauma. Patients with atopic dermatitis may have LSC in areas of former atopic outbreaks.
5. It often occurs on the neck, wrist, forearm, thigh or ankle. Sometimes neurodermatitis affects genital areas such as the vulva or scrotum.
6. The itchiness tends to come and go. It may be most noticeable when you're at rest, watching TV or sleeping.

Treatment

1. The primary treatment is to stop scratching the skin. This may include counseling to become aware of the importance of not scratching or stress management.
2. Topical steroids may also be used for treatment because they decrease inflammation and itch while concurrently softening the hyperkeratosis.
3. Oral antianxiety medications and sedation may be given in certain cases. Antihistamines such as diphenhydramine or hydroxyzine etc. can be used.
4. Bandages or dressings can be used to cover the itching area. It helps protect the affected area and also help in controlling the scratching.
5. Reducing the buildup of thick skin may require medicines that dissolve or melt keratin, the major chemical in skin's outer layer. These keratolytics include urea, lactic acid, and salicylic acid.