Lichen Simplex Chronicus: Symptoms, Causes & Treatment

Definition

Lichen simplex chronicus (LSC) (neurodermatitis) is a localized, chronic dermatitis resulting from a scratch-itch cycle: pruritus → scratching → lichenification → more itch.

Clinical Features

• Single or few plaques – well-demarcated, lichenified (thickened, leathery, exaggerated skin lines).
• Color: Hyperpigmented (violaceous-brown) or erythematous.
• Distribution: Accessible sites – nape of neck, ankles, wrists, forearms, scalp, vulva/scrotum, perianal.
• Symptoms: Intense pruritus (worse at night, with heat/sweat), burning, pain if fissured.
• Excoriations, hemorrhage, secondary infection common.

Triggers & Predisposing Factors

• Atopic dermatitis, contact allergy, insect bite, xerosis
• Psychological stress, anxiety, OCD spectrum
• Neuropathic itch (brachioradial pruritus, notalgia paresthetica)

Treatment Ladder

1. Break the cycle: Occlusive barrier (Unna boot, tape), night gloves.
2. Potent topical corticosteroids (clobetasol) 2–4 wks under occlusion → taper.
3. Intralesional triamcinolone for resistant plaques.
4. Topical calcineurin inhibitors (tacrolimus) for sensitive areas.
5. Oral antihistamines (sedating at night).
6. Treat underlying cause (atopy, contactant, neuropathy).
7. Psychobehavioral: CBT, habit reversal, stress management.

Prognosis

Chronic, relapsing. Long-term control requires addressing both skin and neural/psychological drivers.