Table of ContentsView AllTable of ContentsWhat It Looks LikeCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
What It Looks Like
Causes
Diagnosis
Treatment
Lichen simplex chronicusdescribes thickened, discolored, leathery-looking skin that develops when the skin has been scratched or rubbed over a long period. It’s not a disease but a symptom of prolonged scratching, rubbing, or abrasion.
Lichen simplex chronicus is often diagnosed when no other cause of the condition—other than scratching—is found. But, it can also develop secondary to chronic skin conditions likepsoriasisoreczema. The neck, scalp, ankles, genitals, and forearms are most commonly affected.
The diagnosis is based on the examination of your skin and a review of your medical history. Treatment options include cotton gloves, moisturizers, or over-the-counter (OTC) antihistamines or steroid creams.
This article describes the symptoms, causes, diagnosis, and treatment of lichen simplex chronicus, including how emotional stress can contribute.
What Lichen Simplex Chronicus Looks Like
Itching and scratching are arguably the most prominent signs of lichen simplex chronicus. Chronic (ongoing) scratching can lead to changes in the appearance of the skin, calledlichenification, in which tissues look like lichen that grows on trees and rocks.
Lichen simplex chronicus usually appears as a solitary patch with a round or oval shape. The skin will look dry and scaly with a thick, leathery texture and feel. The patch is often hyperpigmented (darker than the surrounding skin). There will often be visible scratch marks on or around the patch.
The areas most commonly affected sites include:
Over time, lichen simplex chronicus can lead to scarring and long-lasting or permanent changes in pigmentation.
There is also the risk ofsecondary bacterial infections, especially in people with low immune function.Severe cases can lead to an infection calledcellulitisthat affects deeper tissues orsepsis, a potentially deadly immune response to an infection that has spread into the bloodstream.
This photo contains content that some people may find graphic or disturbing.See PhotoLichen simplex chronicus on ankle.Raimo Suhonen / DermNet / CC BY-NC-ND
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
What Triggers Lichen Simplex Chronicus?
Lichen simplex chronicus is a symptom rather than a disease. It is more common in adults and is fairly uncommon in children. It affects females more than males and is most often seen between the ages of 30 and 50.
Lichen simplex chronicus involves habitual scratching that can occur on its own or be secondary to a chronic skin disorder that causespruritus(itching).
The cause may bepsychosomaticor a “tic” that develops in response to anxiety, depression, or other mood disorders (likeobsessive-compulsive disorder).
When it occurs secondary to another skin condition, the common suspects include:
Peripheral neuropathy, a nerve-related symptom that causes burning or tingling sensations, can also lead to chronic scratching. The causes of peripheral neuropathy are many, including diabetes, hypothyroidism, multiple sclerosis, alcoholism, and certain medications.
How Lichen Simplex Chronicus Is Diagnosed
The diagnosis of lichen simplex chronicus is based on an inspection of the skin. The primary aim of the diagnosis is to pinpoint the underlying cause. If no cause is found, lichen simplex chronicus may still be diagnosed and possibly attributed to anxiety or some other psychological cause.
In addition to a physical exam, your healthcare provider may ask questions to determine if you are experiencing high levels of stress or other emotional triggers that might account for the scratching.
They might also review the medications you take to see if any cause peripheral neuropathy (such as amiodarone or certain statin drugs).
Tests your provider may order include:
How Lichen Simplex Chronicus Is Treated
If lichen simplex chronicus is secondary to a chronic skin disorder, the treatment of the disease can often resolve the symptom.
Whether a cause is found or not, the healthcare provider may recommend the following self-care strategies to better manage your symptoms, including:
If scratching is thought to be due to anxiety or depression, antidepressant drugs likedoxepinmay help ease symptoms.
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Summary
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Muylaert BPB, Borges MT, Michalany AO, Scuotto CRC.Lichen simplex chronicus on the scalp: exuberant clinical, dermoscopic, and histopathological findings.An Bras Dermatol. 2018;93(1):108-110. doi:10.1590/abd1806-4841.20186493National Eczema Association.Neurodermatitis.National Library of Medicine: MedlinePlus.Lichen simplex chronicus.Tay EY, Thirumoorthy T, Pang SM, Lee HY.Clinical outcomes of bacteraemia in cellulitis of the leg.Clin Exp Dermatol. 2014;39(6):683-688. doi:10.1111/ced.12366Zagami M, Klepper E, Wienecke E, et al.A review of psychocutaneous disorders from a psychotherapeutic perspective—toolkit for the dermatologist.Skin Health Dis. 2023;3(4):e211. doi:10.1002/ski2.211Emmanuel OM, Karovska AV, Ikedilo O.Scabies-induced lichen simplex chronicus misdiagnosed as psychogenic pruritus: a case report.J Med Case Rep. 2021;15(1):80. doi:10.1186/s13256-020-02628-xStraube R, Müller G, Voit-Bak K, et al.Metabolic and non-metabolic peripheral neuropathy: is there a place for therapeutic apheresis?.Horm Metab Res. 2019;51(12):779-784. doi:10.1055/a-1039-1471Nchinda Ngek ES, Nsioge RM, Ngenge MB, Kadia BM.An intriguing case of lichen simplex chronicus in an elderly sub-Saharan African with longstanding scabies and sensory neuropathy.Pan Afr Med J. 2019;34:124. doi:10.11604/pamj.2019.34.124.19999Ju T, Vander Does A, Mohsin N, Yosipovitch G.Lichen simplex chronicus itch: an update.Acta Derm Venereol. 2022;102:adv00796. doi:10.2340/actadv.v102.4367Buteau A, Reichenberg J.Psychogenic pruritus and its management.Dermatol Clin. 2018;36(3):309-314. doi:10.1016/j.det.2018.02.015
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Muylaert BPB, Borges MT, Michalany AO, Scuotto CRC.Lichen simplex chronicus on the scalp: exuberant clinical, dermoscopic, and histopathological findings.An Bras Dermatol. 2018;93(1):108-110. doi:10.1590/abd1806-4841.20186493National Eczema Association.Neurodermatitis.National Library of Medicine: MedlinePlus.Lichen simplex chronicus.Tay EY, Thirumoorthy T, Pang SM, Lee HY.Clinical outcomes of bacteraemia in cellulitis of the leg.Clin Exp Dermatol. 2014;39(6):683-688. doi:10.1111/ced.12366Zagami M, Klepper E, Wienecke E, et al.A review of psychocutaneous disorders from a psychotherapeutic perspective—toolkit for the dermatologist.Skin Health Dis. 2023;3(4):e211. doi:10.1002/ski2.211Emmanuel OM, Karovska AV, Ikedilo O.Scabies-induced lichen simplex chronicus misdiagnosed as psychogenic pruritus: a case report.J Med Case Rep. 2021;15(1):80. doi:10.1186/s13256-020-02628-xStraube R, Müller G, Voit-Bak K, et al.Metabolic and non-metabolic peripheral neuropathy: is there a place for therapeutic apheresis?.Horm Metab Res. 2019;51(12):779-784. doi:10.1055/a-1039-1471Nchinda Ngek ES, Nsioge RM, Ngenge MB, Kadia BM.An intriguing case of lichen simplex chronicus in an elderly sub-Saharan African with longstanding scabies and sensory neuropathy.Pan Afr Med J. 2019;34:124. doi:10.11604/pamj.2019.34.124.19999Ju T, Vander Does A, Mohsin N, Yosipovitch G.Lichen simplex chronicus itch: an update.Acta Derm Venereol. 2022;102:adv00796. doi:10.2340/actadv.v102.4367Buteau A, Reichenberg J.Psychogenic pruritus and its management.Dermatol Clin. 2018;36(3):309-314. doi:10.1016/j.det.2018.02.015
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Muylaert BPB, Borges MT, Michalany AO, Scuotto CRC.Lichen simplex chronicus on the scalp: exuberant clinical, dermoscopic, and histopathological findings.An Bras Dermatol. 2018;93(1):108-110. doi:10.1590/abd1806-4841.20186493National Eczema Association.Neurodermatitis.National Library of Medicine: MedlinePlus.Lichen simplex chronicus.Tay EY, Thirumoorthy T, Pang SM, Lee HY.Clinical outcomes of bacteraemia in cellulitis of the leg.Clin Exp Dermatol. 2014;39(6):683-688. doi:10.1111/ced.12366Zagami M, Klepper E, Wienecke E, et al.A review of psychocutaneous disorders from a psychotherapeutic perspective—toolkit for the dermatologist.Skin Health Dis. 2023;3(4):e211. doi:10.1002/ski2.211Emmanuel OM, Karovska AV, Ikedilo O.Scabies-induced lichen simplex chronicus misdiagnosed as psychogenic pruritus: a case report.J Med Case Rep. 2021;15(1):80. doi:10.1186/s13256-020-02628-xStraube R, Müller G, Voit-Bak K, et al.Metabolic and non-metabolic peripheral neuropathy: is there a place for therapeutic apheresis?.Horm Metab Res. 2019;51(12):779-784. doi:10.1055/a-1039-1471Nchinda Ngek ES, Nsioge RM, Ngenge MB, Kadia BM.An intriguing case of lichen simplex chronicus in an elderly sub-Saharan African with longstanding scabies and sensory neuropathy.Pan Afr Med J. 2019;34:124. doi:10.11604/pamj.2019.34.124.19999Ju T, Vander Does A, Mohsin N, Yosipovitch G.Lichen simplex chronicus itch: an update.Acta Derm Venereol. 2022;102:adv00796. doi:10.2340/actadv.v102.4367Buteau A, Reichenberg J.Psychogenic pruritus and its management.Dermatol Clin. 2018;36(3):309-314. doi:10.1016/j.det.2018.02.015
Muylaert BPB, Borges MT, Michalany AO, Scuotto CRC.Lichen simplex chronicus on the scalp: exuberant clinical, dermoscopic, and histopathological findings.An Bras Dermatol. 2018;93(1):108-110. doi:10.1590/abd1806-4841.20186493
National Eczema Association.Neurodermatitis.
National Library of Medicine: MedlinePlus.Lichen simplex chronicus.
Tay EY, Thirumoorthy T, Pang SM, Lee HY.Clinical outcomes of bacteraemia in cellulitis of the leg.Clin Exp Dermatol. 2014;39(6):683-688. doi:10.1111/ced.12366
Zagami M, Klepper E, Wienecke E, et al.A review of psychocutaneous disorders from a psychotherapeutic perspective—toolkit for the dermatologist.Skin Health Dis. 2023;3(4):e211. doi:10.1002/ski2.211
Emmanuel OM, Karovska AV, Ikedilo O.Scabies-induced lichen simplex chronicus misdiagnosed as psychogenic pruritus: a case report.J Med Case Rep. 2021;15(1):80. doi:10.1186/s13256-020-02628-x
Straube R, Müller G, Voit-Bak K, et al.Metabolic and non-metabolic peripheral neuropathy: is there a place for therapeutic apheresis?.Horm Metab Res. 2019;51(12):779-784. doi:10.1055/a-1039-1471
Nchinda Ngek ES, Nsioge RM, Ngenge MB, Kadia BM.An intriguing case of lichen simplex chronicus in an elderly sub-Saharan African with longstanding scabies and sensory neuropathy.Pan Afr Med J. 2019;34:124. doi:10.11604/pamj.2019.34.124.19999
Ju T, Vander Does A, Mohsin N, Yosipovitch G.Lichen simplex chronicus itch: an update.Acta Derm Venereol. 2022;102:adv00796. doi:10.2340/actadv.v102.4367
Buteau A, Reichenberg J.Psychogenic pruritus and its management.Dermatol Clin. 2018;36(3):309-314. doi:10.1016/j.det.2018.02.015
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