What are the other Names for this Condition? (Also known as/Synonyms)

• LSC (Lichen Simplex Chronicus)

What is Lichen Simplex Chronicus? (Definition/Background Information)

• Lichen Simplex Chronicus (LSC) is a very common and benign skin disorder that occurs due to constant rubbing and scratching of the skin. In many cases, the individuals are unaware that they are continuously rubbing/scratching the area; it becomes an unconscious habit
• Lichen Simplex Chronicus results in the formation of well-circumscribed plaques. The skin becomes thickened and leathery in the affected area, commonly the arms and legs, head and neck region
• Untreated LSC can lead to bacterial or fungal secondary infections and cause severe emotional and psychological stress due to cosmetic issues. The therapy would involve modification of one’s behavior in order to discourage the individual from itching
• Lichen Simplex Chronicus can be treated through a combination of topical medications, covering the affected region and oral medications, along with proper skin care and maintenance of personal hygiene
• The condition may not be preventable, but the prognosis of Lichen Simplex Chronicus is typically excellent with suitable treatment

Who gets Lichen Simplex Chronicus? (Age and Sex Distribution)

• Lichen Simplex Chronicus (LSC) is observed in individuals over 20 years of age. However, it can be noticed in a wide age range of individuals including children
• Both male and female genders are affected, though a female predilection is observed
• Individuals of all racial and ethnic groups may be affected
• Generally, LSC is more frequently observed among the Asian population

What are the Risk Factors for Lichen Simplex Chronicus? (Predisposing Factors)

Following are the risk factors for Lichen Simplex Chronicus:

• Emotional stress causing constant rubbing and scratching
• Presence of atopic dermatitis
• Anxiety and depression
• Psoriasis can lead to Lichen Simplex Chronicus
• Insect bites in children

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Lichen Simplex Chronicus? (Etiology)

• Lichen Simplex Chronicus (LSC) is the reaction of skin to constant physical trauma. In many cases, itching leads to chronic scratching or rubbing of the skin, which leads to LSC
• LSC is described as a type of neurodermatitis. Neurodermatitis is any skin condition that can be triggered or exacerbated by emotional disturbances such as stress, anxiety, and depression
• It is a common, non-contagious, non-infectious condition. LSC does not spread from one individual to another through physical contact or sharing of items

What are the Signs and Symptoms of Lichen Simplex Chronicus?

The signs and symptoms of Lichen Simplex Chronicus (LSC) may include the following:

• The distinctive characteristic of LSC is chronic and continuous rubbing, itching, or scratching
• The itch occurs in easily accessible areas (accessible to scratching), such as in the arms, legs, head and neck area, including in areas around the anus and genitalia
• The skin may break, causing oozing, or raw skin appearance from intense scratching
• This leads to skin thickening with the appearance of scales; long-term scratching causes thick, leather-like skin (lichenification)
• Formation of well-circumscribed plaques; it can occur in multiple areas
• The skin lesions may be single or multiple
• It can cause hypopigmentation or hyperpigmentation of skin
• The plaques may range in size from 0.5-5.0 cm

How is Lichen Simplex Chronicus Diagnosed?

A few diagnostic tests that are performed for Lichen Simplex Chronicus may include:

• A thorough physical examination and a complete medical history are very crucial; a dermatologist will carefully examine the lesions to help in the diagnosis
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Blood tests, to rule out other causes such as infections
• Potassium hydroxide (KOH) test: The KOH prep involves microscopic observation of skin scrapings for structures belonging to fungi
• Allergy skin test
• Skin biopsy: A biopsy of the lesion is usually performed to confirm the diagnosis. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Note: A tissue biopsy is generally not necessary, but may be performed to rule out other conditions or infections.

A differential diagnosis may be necessary to exclude the following conditions:

• Psoriasis
• Atopic dermatitis
• Irritant contact dermatitis
• Fungal skin infections

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Lichen Simplex Chronicus?

The complications of Lichen Simplex Chronicus could include:

• Fungal, bacterial, or viral infections on the skin surface, due to bleeding and ulceration of the skin lesions
• Permanent scarring, due to long-term intense itching
• Individuals may have emotional and psychological stress due to the constant rubbing/scratching and cosmetic issues arising from the scaly, leathery skin
• Loss of sleep due to intense scratching and discomfort at night

How is Lichen Simplex Chronicus Treated?

The main focus of Lichen Simplex Chronicus treatment involves treating the cause of underlying itching. The following measures may be used to address LSC:

• Behavioral modification therapy and stress management
• Taking proper skin care by avoiding the tendency to itch
• Avoiding activities that can aggravate the condition; avoiding harsh soaps and detergents
• Maintaining cleanliness and proper body hygiene
• Use of moisturizing lotions to prevent the skin from drying
• Use of topical corticosteroid creams and lotions
• The administration of antihistamines, if itching is due to allergic causes
• Antibiotics may be used to treat infections
• Use of occlusive bandages to prevent itching or scratching the skin surface
• Unna Boot: A roll of gauze, medicated with zinc oxide paste is wrapped around the large areas of thickened skin (particularly in the calf region). This is placed for up to 1 week, to prevent scratching and further deterioration of the condition. The Unna Boot can be removed, the skin cleansed, and a new Unna Boot applied to prolong the duration of making the skin inaccessible to the scratching/rubbing behavior. After a few weeks, the thickening diminishes. Once the boot/wrapping is stopped and the region is again accessible, the behavior may be better controlled, or return

How can Lichen Simplex Chronicus be Prevented?

• Currently, it may not be possible to prevent Lichen Simplex Chronicus
• However, maintaining hygiene, keeping the skin moisturized, and avoiding the tendency to itch can help control the symptoms and prevent from worsening of the skin texture
• Clipping the nails short, especially in children, can be beneficial

What is the Prognosis of Lichen Simplex Chronicus? (Outcomes/Resolutions)

The prognosis of Lichen Simplex Chronicus is generally excellent with appropriate treatment and the avoidance of rubbing/scratching the skin.

Additional and Relevant Useful Information for Lichen Simplex Chronicus:

There is no evidence to prove that dietary factors have an influence on Lichen Simplex Chronicus.