Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Lichen Simplex Chronicus Treatment & Management

  • Author: Jason Schoenfeld, MD; Chief Editor: William D James, MD  more...
 
Updated: Mar 30, 2016
 

Medical Care

Treatment is aimed at reducing pruritus and minimizing existing lesions because rubbing and scratching cause lichen simplex chronicus. Location, lesion morphology, and extent of the lesions influence treatment. For example, a thick psoriasiform plaque of lichen simplex chronicus on a limb is commonly treated with a highly potent topical corticosteroid or intralesional corticosteroids, whereas vulvar lesions are more commonly treated with a mild topical corticosteroid or a topical calcineurin inhibitor. Widespread lesions are more likely to require systemic treatment or total body phototherapy.

Topical steroids are the current treatment of choice because they decrease inflammation and itch while concurrently softening the hyperkeratosis.[20, 21, 22] Because lesions are by nature chronic, treatment most likely is lifelong. On larger and more active lesions, a midpotency steroid may be used to treat acute inflammation. Occasionally, occlusion is used to increase potency and enhance delivery of the agent. Occlusion also provides a physical barrier to the scratching. Midpotency topical steroids are not recommended for thin skin (eg, vulva, scrotum, axilla, face). Direct long-term therapy more at daily use of low-potency nontrophogenic topical corticosteroids. High-potency topical corticosteroids may be used for 3-week courses on thicker-skinned areas.

Oral antianxiety medications and sedation may be considered in certain patients. According to individual need, treatment can be scheduled throughout the day, at bedtime, or both. Antihistamines such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) are common. Doxepin (Sinequan) and clonazepam (Klonopin) may be considered in appropriate cases.

For infected lesions, a topical or oral antibiotic can be considered.

Other topical medications reported to decrease pruritus include doxepin cream[23] and capsaicin cream.[24]

One study suggests that topical aspirin/dichloromethane is effective in patients with lichen simplex chronicus who have not responded to topical corticosteroids.[25]

For topical corticosteroid unresponsive patients or those with lesions on thin skin, a few case reports and small studies have shown efficacy of topical immunomodulators tacrolimus and pimecrolimus.[26]

A more investigational treatment for patients who fail conventional therapy is local botulinum toxin injections.[27, 28]

Transcutaneous electrical nerve stimulation (TENS) has been reported as a possible effective treatment in a small, open trial of cases of lichen simplex chronicus resistant to topical corticosteroid treatment.[29]

Next

Consultations

Consultation with a dermatologist may be considered for severe cases requiring more than topical treatments or to facilitate patch testing.

Consultation with an allergist may be considered in individuals with multisystemic atopic symptoms.

Consultation with a psychiatrist may be considered, given the association with underlying depressive and anxiety disorders.

Previous
Next

Complications

Patients with lichen simplex chronicus have higher rates of diabetes mellitus, hyperlipidemia, hypertension, coronary artery disease, peripheral vascular disease, chronic obstructive pulmonary disease, and chronic kidney disease.[6]

Patients with lichen simplex chronicus are more likely to develop erectile dysfunction than age-matched controls. Physicians should be aware of the association between lichen simplex chronicus and erectile dysfunction and advise or arrange timely sexual consultations.[6]

Previous
 
 
Contributor Information and Disclosures
Author

Jason Schoenfeld, MD Resident Physician, Department of Dermatology, University of Buffalo, State University of New York School of Medicine and Biomedical Sciences

Disclosure: Nothing to disclose.

Coauthor(s)

Thomas N Helm, MD Clinical Professor of Dermatology and Pathology, University of Buffalo, State University of New York School of Medicine and Biomedical Sciences; Director, Buffalo Medical Group Dermatopathology Laboratory

Thomas N Helm, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society of Dermatopathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Daniel J Hogan, MD Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Canadian Dermatology Association

Disclosure: Nothing to disclose.

James J Nordlund, MD Professor Emeritus, Department of Dermatology, University of Cincinnati College of Medicine

James J Nordlund, MD is a member of the following medical societies: American Academy of Dermatology, Sigma Xi, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Stephen H Mason, MD 

Stephen H Mason, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery, Women's Dermatologic Society, Skin Cancer Foundation

Disclosure: Nothing to disclose.

Siobahn M Hruby, MD Internal Medicine Physician, Boys Town National Research Hospital

Siobahn M Hruby, MD is a member of the following medical societies: American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

References
  1. Weyers W, Weyers I, Bonczkowitz M, Diaz-Cascajo C, Schill WB. Lichen amyloidosus: a consequence of scratching. J Am Acad Dermatol. 1997 Dec. 37(6):923-8. [Medline].

  2. Weyers W. [Lichen amyloidosus--disease entity or the effect of scratching]. Hautarzt. 1995 Mar. 46(3):165-72. [Medline].

  3. Lotti T, Buggiani G, Prignano F. Prurigo nodularis and lichen simplex chronicus. Dermatol Ther. 2008 Jan-Feb. 21(1):42-6. [Medline].

  4. Tsintsadze N, Beridze L, Tsintsadze N, Krichun Y, Tsivadze N, Tsintsadze M. PSYCHOSOMATIC ASPECTS IN PATIENTS WITH DERMATOLOGIC DISEASES. Georgian Med News. 2015 Jun. 70-5. [Medline].

  5. Liao YH, Lin CC, Tsai PP, Shen WC, Sung FC, Kao CH. Increased risk of lichen simplex chronicus in people with anxiety disorder: a nationwide population-based retrospective cohort study. Br J Dermatol. 2014 Apr. 170 (4):890-4. [Medline].

  6. Juan CK, Chen HJ, Shen JL, Kao CH. Lichen Simplex Chronicus Associated With Erectile Dysfunction: A Population-Based Retrospective Cohort Study. PLoS One. 2015. 10 (6):e0128869. [Medline].

  7. Ball SB, Wojnarowska F. Vulvar dermatoses: lichen sclerosus, lichen planus, and vulval dermatitis/lichen simplex chronicus. Semin Cutan Med Surg. 1998 Sep. 17(3):182-8. [Medline].

  8. Pleimes M, Wiedemeyer K, Hartschuh W. [Lichen simplex chronicus of the anal region and its differential diagnoses : A case series.]. Hautarzt. 2009 Mar 7. [Medline].

  9. Juan CK, Chen HJ, Shen JL, Kao CH. Lichen Simplex Chronicus Associated With Erectile Dysfunction: A Population-Based Retrospective Cohort Study. PLoS One. 2015. 10 (6):e0128869. [Medline].

  10. Simonetta C, Burns EK, Guo MA. Vulvar Dermatoses: A Review and Update. Mo Med. 2015 Jul-Aug. 112 (4):301-7. [Medline].

  11. Guerrero A, Venkatesan A. Inflammatory Vulvar Dermatoses. Clin Obstet Gynecol. 2015 Sep. 58 (3):464-75. [Medline].

  12. Khaitan BK, Sood A, Singh MK. Lichen simplex chronicus with a cutaneous horn. Acta Derm Venereol. 1999 May. 79(3):243. [Medline].

  13. Gerritsen MJ, Gruintjes FW, Andreissen MA, van der Valk PG, van de Kerkhof PC. Lichen simplex chronicus as a complication of herpes zoster. Br J Dermatol. 1998 May. 138(5):921-2. [Medline].

  14. Burkhart CG, Burkhart CN. Acne keloidalis is lichen simplex chronicus with fibrotic keloidal scarring. J Am Acad Dermatol. 1998 Oct. 39(4 Pt 1):661. [Medline].

  15. Woodruff PW, Higgins EM, du Vivier AW, Wessely S. Psychiatric illness in patients referred to a dermatology-psychiatry clinic. Gen Hosp Psychiatry. 1997 Jan. 19(1):29-35. [Medline].

  16. Shukla S, Mukherjee S. Lichen simplex chronicus during lithium treatment. Am J Psychiatry. 1984 Jul. 141(7):909-10. [Medline].

  17. Chey WY, Kim KL, Yoo TY, Lee AY. Allergic contact dermatitis from hair dye and development of lichen simplex chronicus. Contact Dermatitis. 2004 Jul. 51(1):5-8. [Medline].

  18. Ising H, Lange-Asschenfeldt H, Lieber GF, Weinhold H, Eilts M. [Effects of long-term exposure to street traffic exhaust on the development of skin and respiratory tract diseases in children]. Schriftenr Ver Wasser Boden Lufthyg. 2003. 81-99. [Medline].

  19. Thaipisuttikul Y. Pruritic skin diseases in the elderly. J Dermatol. 1998 Mar. 25(3):153-7. [Medline].

  20. Brunner N, Yawalkar S. A double-blind, multicenter, parallel-group trial with 0.05% halobetasol propionate ointment versus 0.1% diflucortolone valerate ointment in patients with severe, chronic atopic dermatitis or lichen simplex chronicus. J Am Acad Dermatol. 1991 Dec. 25(6 Pt 2):1160-3. [Medline].

  21. Datz B, Yawalkar S. A double-blind, multicenter trial of 0.05% halobetasol propionate ointment and 0.05% clobetasol 17-propionate ointment in the treatment of patients with chronic, localized atopic dermatitis or lichen simplex chronicus. J Am Acad Dermatol. 1991 Dec. 25(6 Pt 2):1157-60. [Medline].

  22. Geraldez MC, Carreon-Gavino M, Hoppe G, Costales A. Diflucortolone valerate ointment with and without occlusion in lichen simplex chronicus. Int J Dermatol. 1989 Nov. 28(9):603-4. [Medline].

  23. Drake LA, Millikan LE. The antipruritic effect of 5% doxepin cream in patients with eczematous dermatitis. Doxepin Study Group. Arch Dermatol. 1995 Dec. 131(12):1403-8. [Medline].

  24. Kantor GR, Resnik KS. Treatment of lichen simplex chronicus with topical capsaicin cream. Acta Derm Venereol. 1996 Mar. 76(2):161. [Medline].

  25. Yosipovitch G, Sugeng MW, Chan YH, Goon A, Ngim S, Goh CL. The effect of topically applied aspirin on localized circumscribed neurodermatitis. J Am Acad Dermatol. 2001 Dec. 45(6):910-3. [Medline].

  26. Kelekci HK, Uncu HG, Yilmaz B, Ozdemir O, Sut N, Kelekci S. Pimecrolimus 1% cream for pruritus in postmenopausal diabetic women with vulvar lichen simplex chronicus: A prospective non-controlled case series. J Dermatolog Treat. 2008 Apr 11. 1-5. [Medline].

  27. Heckmann M, Heyer G, Brunner B, Plewig G. Botulinum toxin type A injection in the treatment of lichen simplex: an open pilot study. J Am Acad Dermatol. 2002 Apr. 46(4):617-9. [Medline].

  28. Messikh R, Atallah L, Aubin F, Humbert P. [Botulinum toxin in disabling dermatological diseases]. Ann Dermatol Venereol. 2009 May. 136 Suppl 4:S129-36. [Medline].

  29. Engin B, Tufekci O, Yazici A, Ozdemir M. The effect of transcutaneous electrical nerve stimulation in the treatment of lichen simplex: a prospective study. Clin Exp Dermatol. 2009 Apr. 34(3):324-8. [Medline].

 
Previous
Next
 
Plaque of lichen simplex chronicus demonstrating accentuated skin markings. Courtesy of San Antonio Uniformed Services Health Education Consortium Dermatology Program.
Area of lichen simplex chronicus originally believed to be chronic contact dermatitis. The true nature was revealed when the patient admitted to rubbing this area while watching television. Courtesy of San Antonio Uniformed Services Health Education Consortium Dermatology Program.
Plaques of lichen simplex chronicus on the hand.
Lichen simplex chronicus of the dorsal hand and wrist demonstrating increased skin thickness and accentuation of skin markings.
Plaque of lichen simplex chronicus of the leg with accentuated skin markings and excoriations.
H and E biopsy of lichen simplex chronicus from forearm skin viewed at 40x magnification. Note the characteristic hyperkeratosis, hypergranulosis, pseudoepitheliomatous hyperplasia, and papillary dermal fibrosis.
H and E biopsy of lichen simplex chronicus from forearm skin viewed at 100x magnification. Note the characteristic hyperkeratosis, hypergranulosis, pseudoepitheliomatous hyperplasia, and papillary dermal fibrosis.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.