Merck Manual

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Lichen Simplex Chronicus

(Neurodermatitis)

By

Thomas M. Ruenger

, MD, PhD, Georg-August University of Göttingen, Germany

Full review/revision Jan 2023
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Topic Resources

Lichen simplex chronicus is chronic, itchy inflammation of the top layer of the skin caused by repeated scratching, rubbing, or both.

  • Lichen simplex chronicus involves a cycle in which scratching provokes itching, which provokes more scratching.

  • It most often affects skin areas that are easier to reach, such as the upper chest, arms, neck, legs, and genital area, and often does not affect skin areas that are more difficult to reach, such as the mid to upper back.

  • Corticosteroids applied to the skin and measures to relieve itching help, but people should avoid scratching and rubbing the skin.

Lichen simplex chronicus is caused by chronic scratching or rubbing of an area of skin. The act of scratching triggers more itching, beginning a vicious circle of itching-scratching-itching.

Sometimes the scratching begins for no apparent reason. Other times scratching starts because of a chronic dermatitis Contact Dermatitis Contact dermatitis is skin inflammation caused by direct contact with a particular substance. The rash may be itchy, is confined to a specific area, and often has clearly defined boundaries... read more Contact Dermatitis or other condition, but the person continues to scratch long after the inciting cause is gone. This persistent itch may involve changes in the way a person's nervous system perceives and processes itchy sensations.

Symptoms of Lichen Simplex Chronicus

In the early stages, the skin looks normal, but it itches. Later, dryness, scaling, thickening, and dark patches develop as a result of the chronic scratching and rubbing. This process, called lichenification, causes the skin to resemble leather.

Diagnosis of Lichen Simplex Chronicus

  • A doctor's evaluation

  • Sometimes a skin biopsy

  • For anal or vaginal itching, tests to rule out other possible causes

Doctors base the diagnosis of lichen simplex chronicus on the results of a physical examination and sometimes take samples of skin and send them to a laboratory (biopsy Biopsy Doctors can identify many skin disorders simply by looking at the skin. A full skin examination includes examination of the scalp, nails, and mucous membranes. Sometimes the doctor uses a hand-held... read more Biopsy ). Doctors try to discover any possible underlying allergies or diseases that may be causing the initial itching.

When severe itching occurs around the anus or genital area, the doctor may investigate the possibility of other causes, such as

Treatment of Lichen Simplex Chronicus

  • Measures to relieve itching and to help people stop scratching and rubbing

  • Corticosteroids

  • Antihistamines

If a cause for the itch can be identified, it is treated.

A potent corticosteroid ointment is applied to the area. People can increase the effects of the corticosteroid ointment by covering the area with plastic wrap and leaving it on overnight. Commercial surgical tape products that are saturated with a corticosteroid help relieve itching and inflammation and protect the skin from scratching. For small areas, the doctor may inject longer-acting corticosteroids under the skin to control the itching.

Doctors may give antihistamines by mouth. Moisturizing agents (emollients) and capsaicin cream may also be applied to the affected areas.

When this disorder develops around the anus or genital area, the best treatment is a corticosteroid cream.

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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