Definition

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

Alternative Names

LSC; Neurodermatitis circumscripta

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 adults but may also be seen in children.

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 (often during sleep) 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 the skin
• Raw areas of skin
• Scaling
• Skin lesion, patch, or plaque with sharp borders and a leathery texture, located on the ankle, wrist, back of the 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, lactic acid, or urea on patches of thick skin

You may 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. Wearing cotton gloves at night may prevent skin damage from scratching.

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. While the condition can be treated, it often returns. The condition may return or move to different areas on the skin. Ongoing management can help relieve symptoms.

Possible Complications

These complications of LSC can occur:

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

When to Contact a Medical Professional

Contact 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

Dinulos JGH. Eczema and hand dermatitis. In: Dinulos JGH, ed. Habif's Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 3.

James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Pruritus and neurocutaneous dermatoses. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 4.

Patterson JW. The psoriasiform reaction pattern. In: Patterson JW, ed. Weedon's Skin Pathology. 5th ed. Philadelphia, PA: Elsevier Limited; 2021:chap 5.

Renzi MA, Sommer LL, Baker DJ. Lichen simplex chronicus. In: Lebwohl MG, Heymann WR, Coulson IH, Murrell DF, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 6th ed. Philadelphia, PA: Elsevier, 2022:chap 138.

Zug KA. Eczema. In: Habif TP, Dinulos JGH, Chapman MS, Zug KA, eds. Skin Disease: Diagnosis and Treatment. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 2.