Lichen Simplex Chronicus - Western SummaryWestern Medicine Summary

Western Medicine

Western Summary

Lichen simplex chronicus is a chronic skin condition that develops due to repeated scratching and rubbing.

Symptoms

It appears as a plaque that is thickened, dry, and typically has a scaly and leathery texture. The affected skin is often dark in color and accompanied by scratch marks. The person may have a single or multiple lichen simplex chronicus lesions. It more commonly affects a person’s dominant side of the body and areas that can be easily reached by hands, such as back of the neck or scalp, genitals, wrists, forearms, and lower legs.

 

Causes

The most common underlying skin problem that causes lichen simplex chronicus is itching from eczema, local irritation, anxiety, neuropathy, or another condition that leads to chronic itching.[1] Lichen simplex chronicus may also develop from repeated habitual rubbing. The affected person may often scratch at night without realizing it. Lichen simplex chronicus is more common in adults than children, and is more common in people with high anxiety or obsessive-compulsive disorders (OCD).  

 

Treatments

It is important to seek attention from a qualified health provider to rule out conditions that may cause chronic itching. LSC develops due to the itch-scratch cycle where itching and scracthing lead to thickening, causing more itching and scratching, and so on.

Topical Medications

  • Moisturizers: Frequent moisturizers can help reduce skin dryness and itching.
  • Steroids: Steroids can help with reducing the itching and skin inflammation. They help to break the itch-scratch cycle. 
  • Topical menthol and capsaicin: Creams or lotions that contain capsaicin and menthol may help sooth the skin and decrease itching.

Oral Medications

Oral medications typically require a prescription from a qualified health provider. 

  • Antihistamines: Antihistamines are frequently prescribed to break the itch-scratch cycle. Antihistamines that are non-sedating do not seem to improve itch,[2] although sedating antihistamines may anecdotally improve nighttime itching [2]and increase sleep quality.[3] 
  • Mood medications such as antidepressants, anti-anxiety and anti-seizure medications may help with skin sensation changes, scratching habits and anxiety.
  • Other systemic anti-inflammatory medications such as steroids, methotrexate, azathioprine, and cyclosporine may be used in persistent cases.
  • Steroid injections: Injecting steroids into LSC lesions may help with itching and inflammation.
  • Phototherapy may be used to decrease skin inflammation and itching.

1.    Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. Elsevier Limited; 2012.

2.    Klein PA, Clark RF. An evidence-based review of the efficacy of antihistamines in relieving pruritus in atopic dermatitis. Archives of Dermatology.1999;135(12):1522-1525; PMID.

3.    Ozdemir PG, Karadag AS, Selvi Y, et al. Assessment of the effects of antihistamine drugs on mood, sleep quality, sleepiness, and dream anxiety. Int J Psychiatry Clin Pract.2014;18(3):161-168; PMID: 246734