Lichen Simplex Chronicus

Who's At Risk?

Lichen simplex chronicus can occur in people of any age, race / ethnicity, or sex. However, it is more common in women and appears more frequently in middle-aged and older adults.

Conditions that can lead to a scratch-itch cycle that can cause lichen simplex chronicus include:

• Insect bites.
• Scars.
• Eczema (atopic dermatitis).
• Dry skin (xerosis).
• Poor circulation in legs (venous insufficiency).
• Anxiety and stress.

Signs & Symptoms

Although it can occur anywhere on the body that the person can reach, lichen simplex chronicus is most commonly seen on the:

• Scalp.
• Sides and back of the neck.
• Genitals (vulva, scrotum, perineum).
• Knees, lower legs, shins, and ankles.

Each plaque (a slightly raised area of skin larger than a thumbnail) of lichen simplex chronicus appears as leathery, thickened skin in which the normal skin lines are exaggerated. The thickened skin is darker than surrounding skin (hyperpigmented). In lighter skin colors, the lesions are often pink, red, or purple, and in darker skin colors, they are often brown, purple, or grayish. The hyperpigmentation is especially apparent in darker skin colors.

Individuals with lichen simplex chronicus report periodic itching that is most intense at night or any time they are not active.

Self-Care Guidelines

• The primary treatment is to stop scratching. However, this can be very difficult once a scratch-itch cycle has started. Areas of lichen simplex chronicus may need to be covered at night, as many people scratch in their sleep.
• Use moisturizers to help relieve itchy skin. When choosing a moisturizer, look for oil-based creams and ointments (eg, CeraVe Healing Ointment, CeraVe Moisturizing Cream), which work better than water-based lotions. Apply moisturizers just after bathing, while the skin is still moist.
• Apply over-the-counter hydrocortisone cream (eg, Cortizone-10) or take an antihistamine (eg, cetirizine [Zyrtec] or diphenhydramine [Benadryl]) to decrease the itch. If the itching is limited to the groin area, you may have a fungal infection (ie, tinea cruris, or jock itch) rather than lichen simplex chronicus; do not apply hydrocortisone to the groin area unless recommended to do so by a medical professional.
• If there are breaks or cracks in the skin, apply an antibiotic ointment to prevent infection (eg, Neosporin, Polysporin).

Treatments

The medical professional will look for an underlying cause of the itch and will advise on how to break the scratch-itch cycle. In addition to the above self-care measures, your medical professional may recommend one or more of the following treatments to reduce itching and scratching:

• Prescription corticosteroid (cortisone) creams or ointments
• Prescription oral antihistamines, especially for use at bedtime
• Injection of corticosteroid solution directly into the lichen simplex chronicus lesions
• Ultraviolet light therapy if the lichen simplex chronicus is widespread
• Behavioral therapy, sedatives, or antidepressants for people with lichen simplex chronicus strongly related to psychological stress
• Oral doxepin
• Topical or oral antibiotics if infection is present

Visit Urgency

See your medical professional if the itching does not improve with self-care measures, if you are developing more lesions, or if you develop symptoms of infection such as pain, redness, drainage of pus, or fever.

Trusted Links

• MedlinePlus: Itching
• Clinical Information and Differential Diagnosis of Lichen Simplex Chronicus

References

Bolognia J, Schaffer JV, Cerroni L. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018.

James WD, Elston D, Treat JR, Rosenbach MA. Andrew’s Diseases of the Skin. 13th ed. Philadelphia, PA: Elsevier; 2019.

Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology. 9th ed. New York, NY: McGraw-Hill Education; 2019.