Table of Contents
Definition of Lichen Simplex Chronicus
Over time, the involved areas develop hyperkeratosis, an overgrowth of keratinocytes that gives the areas a scaly, lichen like appearance (plaques). Lichen simplex chronicus sometimes develops in areas of the skin that have previously had irritation, such as from dermatitis or abrasive injury, or frequently irritated, such as from clothing that rubs or constricts.
Stress and strong emotional responses exacerbate the rash and the itching. The condition appears more common in people who have depression or anxiety, hence the former term, neurodermatitis, for the condition. Most often, however, there is no clear cause for the condition.
Symptoms and Diagnostic Path
The rash of lichen simplex chronicus begins with small reddened areas (macules) that itch, commonly forming on the neck and the inner surfaces of the arms and legs. Most people who have lichen simplex chronicus describe the itching as intense, such that they are unable to stop scratching. With scratching, the rash becomes more extensive.
Many people find the itching more pronounced at night before sleep, creating difficulty falling asleep or staying asleep. The dermatologist typically diagnoses lichen simplex chronicus on the presentation of these symptoms, though may choose to biopsy questionable lesions to confirm the diagnosis.
Treatment Options and Outlook
Treatment targets relieving the symptoms, primarily the itching. The dermatologist may prescribe oral antihistamine medications and topical corticosteroid medications, which work together to mitigate the immune system’s response to the persistent irritation scratching causes. Antihistamine medications are especially helpful at bedtime, when many people find the itching most intense, as they tend to cause drowsiness.
Some people benefit from antianxiety medications. Methods such as visualization, biofeedback, and acupuncture may help. Mild to moderate lichen simplex chronicus generally heals without residual effects, though more severe manifestations may leave scarring and altered pigmentation (either lighter or darker patches of skin in the sites of the healed plaques).
Risk Factors and Preventive Measures
The causes of lichen simplex chronicus remain elusive. Dermatologists disagree on whether the rash or the itching appears first, though the end result is that the rash itches and continued scratching perpetuates the rash. The most important factor is to avoid scratching, as persistent scratching causes other damage to the skin that increases the risk for infection and scarring. In many people, episodes follow stressful experiences. Stress management techniques and relaxation methods provide other means for diffusing the physiologic effects of stress.
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