Lichen simplex

Lichen simplex chronicus, as the condition is known in full, is a common, chronic skin inflammation. Typical symptoms are dry, flaky, thickened skin that itches badly.

The itchy areas are often on the neck, arms and legs, the scalp, and the genital organs. Inflamed patches of skin occur due to excessive rubbing or scratching. This makes the itching worse. More scratching results in a cycle.

The condition presents as single or multiple sites on the skin that repeatedly and spontaneously start to itch severely. The itching is made worse by, for example, heat, sweating, or particular items of clothing. It may also be worse at night, when it disrupts sleep.

The changes to the skin typically occur in these places:

• neck
• scalp
• arms, particularly elbows
• hands
• legs, particularly knees
• inner thighs
• genital organs, particularly vulva and testicles

The inflamed skin becomes thick or even leathery due to repeated rubbing and scratching. Affected areas are often dry, pale or reddened, and cracked and flaky.

If the itching is particularly stubborn, frequent scratching can damage deeper layers of the skin and cause bleeding. If the scalp is affected, this can cause hair to fall out.

Various irritants can cause increased itching. Excessive scratching leads to more skin irritation which, in turn, leads to increased itching: an “itch and scratch” cycle emerges.

These irritations may emerge due to:

• mechanical rubbing, for example due to coarse clothing
• heat and sweating
• insect stings, bites from lice or other parasites
• ointments applied locally, for example against thrush
• irritants such as creams, soaps, shaving foam, sanitary towels, tampons, or perfumed toilet paper
• (emotional) stress

Certain illnesses can also cause increased itching.

These include skin conditions such as:

• neurodermatitis
• psoriasis
• thrush, particularly in the vagina
• warts
• lichen sclerosus 
• contact allergies, for example to nickel

But kidney, liver, thyroid gland and blood cell illnesses can also be triggers.

The probability of getting lichen simplex increases if there are conditions in the family such as:

• allergies and allergy-related inflammation of the nasal mucous membrane (rhinitis)
• contact allergies caused by sensitivity to specific substances such as jewelery containing nickel
• asthma
• neurodermatitis

It is mainly people aged between 35 and 50 who develop lichen simplex. The condition is twice as common in women as in men. But children, too, may have lichen simplex symptoms.

Constant scratching can damage the skin. These areas then get inflamed easily and may be a gateway for germs to enter. 

The skin cells can also be changed or damaged so that the skin is no longer able to regenerate properly. In very rare cases, cancer can occur in damaged skin.

There is no specific test to diagnose lichen simplex. During a thorough consultation the doctor will ask, for example, where and how often the itching occurs, and whether there are any known pre-existing conditions.

Skin samples help identify the thickenings of the horny layer of the skin which characterizes lichen simplex, and any other changes to the skin.

Evidence of possible fungal infections can also be found under the microscope or in the laboratory.

The treatment aims to break the “itch and scratch” cycle. So doctors try to get rid of everything that triggers the itching if possible.

If lichen simplex is the symptom of another condition, it is the latter that should be treated.

If the itching and inflammation is severe, anti-inflammatory cortisone ointments can help alleviate the symptoms.

If the itching is disrupting sleep, antihistamines can help. They soothe and act against allergic reactions.

In severe cases, under certain circumstances, light therapy using UVA and UVB rays may be an option.

The constant itching that comes with lichen simplex can be very stressful. Simple measures help alleviate the symptoms and cope with everyday life.

• Acute itching can be soothed using ice, cold compresses, or anti-itching products containing menthol.
• Irritated areas of skin can be protected by oil-replenishing, hygroscopic care products. These should be applied immediately after showering, when the skin is still damp.
• It is best to replace any irritating textiles or body care products with soothing products.
• To prevent unintentional scratching during sleep, it helps to keep fingernails short or wear gloves.