Lichen Simplex Chronicus (Neurodermatitis)

Lichen simplex chronicus, also called neurodermatitis, happens when a patch of skin becomes thick and rough from repeated itching and scratching. The itch can be intense, and scratching makes it worse.

This type of eczema affects about 1 in 8 people worldwide.

This condition can appear anywhere on your body. But it’s most common on your arms, legs, neck or other visible areas.

The constant itch and irritation can also cause stress or anxiety. This may make symptoms feel stronger. A healthcare provider can help you find ways to calm the itch, care for your skin and feel more comfortable.

Lichen simplex chronicus symptoms

Symptoms can come and go without warning. They may feel worse when you relax, especially before falling asleep. Common symptoms include:

• Intense itching
• Skin color changes with distinct borders (red, purple, gray, brown or darker than your natural tone)
• Thick, dry or scaly plaque that feels rough or leathery

Scratching can make things worse. It irritates the nerves in your skin, causing more itching. This leads to what’s called the itch-scratch cycle.

Where do symptoms appear?

This condition can affect many parts of your body. The most common areas include:

• Arms, hands, shoulders, wrists or elbows
• Neck, face, scalp, lips or cheeks
• Genital area (scrotum, vulva or around the anus)
• Legs and ankles

Lichen simplex chronicus causes

Healthcare providers aren’t sure what causes lichen simplex chronicus. It may happen when the nerves in your skin become overly sensitive. Certain things can trigger (start) the itching and scratching cycle, creating a reaction between your mind and body.

Common triggers include:

• Allergic reactions
• Bug bites
• Dry skin
• Emotional stress, anxiety or depression
• Heat or sweating
• Skin injuries
• Tight clothing

Risk factors of lichen simplex chronicus

This condition can affect anyone. It’s most common in adults between ages 30 and 50. Providers diagnose it more often in females than in males.

You may have a higher risk if you also have:

• Anxiety or obsessive-compulsive disorder
• Kidney disease
• Other skin conditions, like psoriasis and contact dermatitis
• Stress

Complications of lichen simplex chronicus

Constant itching and scratching may cause:

• Pain or a burning feeling
• Open sores or bleeding
• Skin infections (crust, sores oozing fluid or pus-filled bumps)
• Swelling or raised skin (inflammation)
• Trouble sleeping
• Scarring
• Hair loss (if scratching happens on your scalp)

In rare cases, long-term skin irritation can lead to certain types of skin cancer, like squamous cell carcinoma. If you notice new or changing patches, contact a healthcare provider for a skin check.

How doctors diagnose lichen simplex chronicus

A primary care physician or dermatologist can diagnose this condition. They’ll look closely at the itchy area of your skin. Then, they’ll ask about your medical history and daily habits. Some questions may include:

• When did the itching start?
• Is the itch constant, or does it come and go?
• Have you tried any home treatments?
• Have you changed soaps, lotions or skin care products recently?

What tests diagnose lichen simplex chronicus?

Sometimes, testing helps confirm the diagnosis or rule out other skin conditions.

Your provider may recommend one or more of the following:

• Patch test
• Culture test
• Skin biopsy

Lichen simplex chronicus treatment

Treatment is different for everyone. The main goal is to stop the itch-scratch cycle and help your skin heal. Your provider may recommend:

• Covering the area: Keeping the spot covered may prevent scratching.
• Moisturizers: These help keep your skin soft and protect it from drying out.
• Prescription creams: Some can reduce swelling and itching, numb the area or calm your skin’s immune response.
• Light therapy: Special light treatments may help severe cases.
• Therapy or counseling: Stress and anxiety can make itching worse. Talking with a mental health provider may help.

What medications treat lichen simplex chronicus?

Your provider may recommend medicines to manage symptoms, like:

• Corticosteroids: These reduce discoloration, swelling, itching and tenderness. They can also soften thick, rough skin. You usually apply them as a cream or ointment.
• Antihistamines: These may prevent allergic reactions that can trigger itching.
• Antibiotics: These prevent or treat bacterial infections if scratching breaks your skin. You may use them as a cream or take them as pills.
• Capsaicin creams: Made from chili peppers, these can numb the nerves in your skin to relieve pain and itching.
• Tacrolimus cream: This medicine helps calm your immune system and reduce inflammation when steroids don’t work well.
• Pimecrolimus cream: Similar to tacrolimus, this cream lowers inflammation and helps manage itching without thinning your skin.

What should I do if scratching causes a wound?

If you scratch and break your skin, it’s important to take care of the wound right away to prevent infection. Follow these steps:

1. Clean the area. Rinse your skin under cool water. Use mild soap and a soft cloth to gently wash the area. Pat dry with a clean towel.
2. Apply petroleum jelly. Put a small amount on the wound to prevent infection.
3. Cover it. Place a clean bandage over the area. Change the bandage at least once a day or if it gets wet or dirty.
4. Keep an eye on the wound. If it changes color, swells, is painful or starts to ooze, contact your healthcare provider.

What can I do to help my skin heal?

If you have lichen simplex chronicus, follow your provider’s treatment plan closely. You can also try these steps at home to help your skin heal:

• Avoid scratching. This can be easier said than done, but try not to scratch the itchy area. If you have to, use the pads of your fingers instead of your nails so you don’t break your skin.
• Soothe the itch. Use ice packs, anti-itch creams, a cool compress or take a cool bath to calm your skin.
• Stay cool. Try to keep your body at a comfortable temperature and avoid getting overheated.
• Wear soft, loose clothing. Choose cotton or other gentle fabrics that won’t irritate your skin.
• Keep itchy areas covered. Light clothing or bandages may remind you not to scratch.

When should I see my healthcare provider?

See a healthcare provider if you have long-lasting itchy skin. It’s important to contact a provider right away if you notice signs of infection, like:

• A fever
• A wound that isn’t healing
• Severe pain or swelling

Getting treatment early can help your skin heal and prevent complications.

How long does it take to heal lichen simplex chronicus?

It can take several weeks for your skin to heal. Some medicines may stop the itching quickly. You might still see a mark or darker patch where the rash was. On average, healing takes about four to six weeks.

Even after your skin clears, the condition can come back or appear in a different spot later.

Does lichen simplex chronicus go away?

With proper treatment, the plaque on your skin may go away. But you’ll have to follow your provider’s treatment plan to keep symptoms at bay. Symptoms can come back after your skin fully heals. It’s important to work closely with your provider to figure out what triggers these symptoms and make a plan to avoid those triggers if possible.

Is there a cure for lichen simplex chronicus?

There isn’t a quick or one-time cure for this condition. It’s not like an infection that goes away after taking medicine. You’ll need ongoing care to prevent it from coming back.

Can lichen simplex chronicus be prevented?

Because the exact cause of lichen simplex chronicus isn’t known, there’s no sure way to prevent it. But you can lower your risk of flare-ups by:

• Avoiding irritants and allergens that trigger itching or rashes
• Choosing gentle skin-care products that are fragrance-free or made for sensitive skin
• Managing stress through relaxation, regular physical activity or mindfulness
• Moisturizing daily to protect and soothe your skin
• Staying cool with a fan or air conditioner if you live in a warm climate
• Treating underlying conditions (like psoriasis or allergies) early to prevent chronic itching
• Using a humidifier to keep indoor air from drying out your skin

Is lichen simplex chronicus an autoimmune disease?

No, lichen simplex chronicus (neurodermatitis) isn’t an autoimmune disease. With autoimmune diseases, your immune system attacks healthy cells by mistake. That’s not what happens with this condition.

Irritation and scratching cause lichen simplex chronicus, not by your immune system attacking your skin.