Lichen Simplex Chronicus

This is a localized itchy, well defined eruption. It usually starts with small papules that join together to become plaques. The chronic nature of this condition can be troubling. The skin thickens in response to rubbing and scratching (lichenification). Increased skin markings occur often in a cross-hatch pattern. Nodules may sometimes occur as part of the thickening skin.

These individuals may be atopic. The cause is not known. Once the itch/scratch cycle is established it is very difficult to break this without treatment. Persistent rubbing causes the epidermis to thicken. Secondary infection of the skin is sometimes seen. There may be sensitization with allergic reactions in response to the topical creams, lotions and ointments used.

Most often lichen simplex chronicus is seen around the ankles, shins and the back or side of the neck. The forearms may also be extensively involved. Involvement of the anal-genital areas, especially on the vulva, scrotum and peri-anal areas is also possible. The plaques produced can be either single or in multiple locations.

Treatment:

The aim of treatment is to stop the itch/scratch cycle. Potent topical steroids are usually required. Occlusion is sometimes necessary to try to reduce the itching and to thin out the excessively thickened skin. The response may often take many weeks. Oral antihistamines that are sedating may be of benefit at bedtime. Secondary infection may be seen and topical or sometimes oral antibiotics are required. The use of Doxepin cream or Capsaicin cream can sometimes help reduce itching.

In persistent lesions a biopsy is required to rule out any other pathology. Occasionally patch testing may also be of value.

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