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Lichen Simplex Chronicus – Neurodermatitis

What is neurodermatitis (lichen simplex chronicus)?

Lichen simplex chronicus (lie-KEN SIM-plex kronik-CUS) is a form of eczema that starts as an itchy, scaly patch of skin that usually appears on the neck, wrist, forearm, thigh, ankle or genitals.

Scaly skin due to lichen simplex chronicus.

Scaly skin due to lichen simplex chronicus.

It’s also known as neurodermatitis because it’s considered a neurological skin disorder fueled by the itch-scratch cycle. Lichen simplex chronicus (neurodermatitis) appears in patches on the neck, scalp, shoulders, feet, ankles, wrists and hands. The affected patch of skin becomes thick, leathery and even itchier the more it is rubbed or scratched as a result of irritated nerve endings in the skin.

Like atopic dermatitis, the itchy areas can become thick, discolored and marked. Unlike atopic dermatitis, the specific patches tend to always be present while the rest of the skin remains healthy.

What does lichen simplex chronicus – neurodermatitis look like?

Symptoms of lichen simplex chronicus (nummular eczema) include:

  • Leathery, thickened skin
  • Dark patches on the skin
  • Pronounced skin lines in the patches

What causes lichen simplex chronicus – neurodermatitis?

The cause of lichen simplex chronicus (neurodermatitis) is unknown, but certain triggers such as an insect bite and stress seem to play a role. In lichen simplex chronicus (neurodermatitis), the nerves in the skin appear be overly ready to tell the brain that there is itch. Sometimes, lichen simplex chronicus (neurodermatitis) can occur with a skin allergy.

Lichen simplex chronicus – neurodermatitis treatment

Not scratching and rubbing the affected areas is key to healing the skin. Cutting fingernails very short and applying ice or an anti-itch preparation can be helpful in preventing scratching.

lichen simplex chronicus

Thick, scaly patches with deep skin lines occur when the skin is repeatedly rubbed.

In some situations, performing patch testing to look for allergens and then avoiding those substances can help.

Like most types of eczema, lichen simplex chronicus (neurodermatitis) benefits from moisturizers to calm and protect the damaged skin. Heavy moisturizers may also help protect the area from rubbing and scratching.

Covering the skin (also known as occlusion) with socks, gloves, and even gauze wraps may also help the skin heal by disrupting the itch-scratch cycle and allowing the moisturizer to deeply penetrate. Unna boots (gauze impregnated with zinc oxide paste) are particularly helpful for lichen simplex chronicus (neurodermatitis).

Neurodermatitis - Image: Skinsight.com

Chronic rubbing or scratching of the same area leads to lichen simplex chronicus (neurodermatitis), with thickened, rough, and sometimes, broken skin areas.

Topical steroid medication can help calm the inflammation and itch. Because the skin tends to be very thick and scaly in lichen simplex chronicus, stronger steroids may be required.

In cases where corticosteroids are not appropriate, or when they have been used for a long time, a non-corticosteroid topical medication such as tacrolimus (Protopic) or pimecrolimus (Elidel) may be prescribed.

In severe cases, steroids may be injected into the lesions to allow them to penetrate the thickened skin.