Background

Skin conditions known as Lichen Simplex Chronicus (LSC) are characterized by persistent itching and scratching, which can result in thicker, leathery, and occasionally discolored skin patches.  

LSC is frequently brought on by persistent skin rubbing or scratching, which may begin as a reaction to an itchy bug bite, irritation, or another skin condition such as eczema. The persistent scratching eventually causes the skin to thicken and become itchier, starting a vicious cycle that makes the condition worse. 

High levels of localized itching are the main sign of LSC. Thicker, scaly patches of skin that may appear darker than the surrounding skin are caused by this chronic itching.

Epidemiology

As a skin disorder, lichen simplex chronicus is regarded as common prevalent. All ages can be affected, but adults experience them more frequently.  

Adults, especially those in their 30s to 50s are more likely to have LSC. Males and females are equally susceptible, suggesting that there is no discernible gender preference. 

Itchy underlying skin disorders like psoriasis, eczema, or allergic reactions frequently lead to the development of LSC. The chance of acquiring LSC is increased in those with several underlying skin disorders.

Anatomy

Pathophysiology

The release of neurotransmitters from cutaneous nerve fibers includes substance P and calcitonin gene-related peptide (CGRP), is hypothesized as mechanism of itching in LSC.  

Both peripheral and central sensitization of the nerve pathways responsible for sending itch signals can occur by prolonged itching and scratching.  

Skin disorders that weaken the skin barrier, including psoriasis or eczema, are common causes of LSC.

Etiology

LSC frequently develops because of persistent friction, rubbing, or scratching of the skin. Numerous things, including bug bites, clothing rubbing against the skin along with underlying skin disorders like psoriasis or eczema, or even stress-induced scratching may cause LSC. 

LSC can develop and persist in part due to the exacerbation of itching and scratching behavior occur by psychological stress, worry, sadness, and other emotional causes.  

Through the itch-scratch cycle, the chronic irritation brought on by these circumstances may contribute to the development of LSC.

Genetics

Prognostic Factors

It is more difficult to control symptoms and avoid relapses the longer LSC is left untreated. The worst symptoms includes severe itching and widespread skin damage. Better results can be achieved with early management and intervention.  

LSC frequently appears as a side effect of other underlying skin disorders such psoriasis, eczema, or allergic reactions that can cause itching. The prognosis of LSC may be affected by the existence and severity of various underlying skin diseases. 

Addressing and managing these psychological factors through counseling, therapy, or other interventions can improve the prognosis of LSC.

Clinical History

Age Group:  

LSC is more commonly observed in adults, particularly between the ages of 30 and 50. While less common than in adults, LSC can also occur in children and adolescents.  

Associated Comorbidity or Activity:   

LSC frequently develops secondary to atopic dermatitis, a chronic inflammatory skin condition characterized by itching, redness, and scaling. The persistent itching and scratching in atopic dermatitis can lead to the development of LSC. 

Psoriasis is another chronic inflammatory skin condition characterized by red, scaly patches on the skin. Individuals with psoriasis may also experience itching, which can lead to LSC in affected areas. 

Allergy-induced contact dermatitis can be brought on by allergic reactions to specific materials, including metals, cosmetics, or topical treatments. Through the itch-scratch cycle, the itching brought on by allergic contact dermatitis may aid in the development of LSC. 

Acuity of Presentation: 

LSC typically develops gradually over time, often starting as acute itching or irritation in response to an underlying trigger, such as eczema, psoriasis, or contact dermatitis.  

The itching sensation can interfere with daily activities and disrupt sleep, leading to significant discomfort and distress for affected individuals. 

Over time, repeated scratching leads to characteristic skin changes in the affected area, including thickening of the skin, scaling, hyperpigmentation, and sometimes the development of nodules or plaques.

Physical Examination

• Location of Lesions: LSC lesions are commonly found in specific areas of the body where scratching is most frequent. Common sites include the neck, scalp, wrists, ankles, genital area, and other areas easily accessible for scratching.  
• Assessment of Skin Integrity: The healthcare provider will assess the integrity of the skin, looking for signs of excoriation, erosions, or open wounds resulting from scratching.  
• Evaluation for Underlying Skin Conditions: Since LSC often develops secondary to underlying skin conditions such as eczema, psoriasis, or allergic contact dermatitis, the healthcare provider may examine the skin for signs of these conditions. 

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

• Atopic Dermatitis: Atopic dermatitis shares some similarities with LSC, including chronic itching and skin changes such as lichenification. 
• Psoriasis: Psoriasis is characterized by well-defined, red, scaly plaques that can be mistaken for lichenified skin in LSC. 
• Allergic Contact Dermatitis: Allergic contact dermatitis can cause itching, redness, and skin changes like LSC, but the distribution of lesions may provide clues to the diagnosis. 
• Prurigo Nodularis: Prurigo nodularis is a condition characterized by intensely itchy nodules or papules that may resemble LSC lesions.

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

• Identification and Management of Underlying Conditions: Since LSC often develops secondary to underlying skin conditions such as eczema, psoriasis, or allergic contact dermatitis, identifying and effectively managing these conditions is essential. 
• Topical Treatments: Topical corticosteroids are commonly used to reduce inflammation, itching, and skin thickening in LSC. High-potency corticosteroids may be prescribed for short-term use to alleviate symptoms, followed by lower-potency corticosteroids for maintenance therapy.  
• Moisturizers and Emollients: Regular use of moisturizers and emollients can help hydrate the skin, reduce itching, and improve skin barrier function in LSC. 
• Psychological Support and Counseling: Given the strong association between LSC and psychological factors such as stress, anxiety, and depression, psychological support and counseling are essential components of treatment.

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

use-of-non-pharmacological-approach-for-lichen-simplex-chronicus

• Temperature and Humidity Control: Maintaining a comfortable indoor environment with stable temperatures and humidity levels can help minimize itching and discomfort associated with LSC. 
• Bedding and Linens: Using soft, hypoallergenic bedding and linens can help minimize skin irritation and itching during sleep. Washing bedding regularly in hypoallergenic detergent and avoiding fabric softeners or fragrances that can irritate the skin may also be beneficial. 
• Air Filtration: Using air purifiers or HEPA filters in the home can help remove airborne allergens, pollutants, and irritants that may trigger itching and exacerbate LSC symptoms.  
• Avoiding Irritants: Identifying and avoiding potential irritants or allergens in the environment, such as harsh chemicals in cleaning products, fragrances, or personal care products, can help prevent skin irritation and minimize itching in individuals with LSC. 
• Stress Reduction: Creating a calm and relaxing environment can help reduce stress and anxiety, which are common triggers for itching and scratching behavior in LSC. 
• Hydration: Maintaining adequate hydration by drinking plenty of water and using humidifiers in dry indoor environments can help prevent skin dryness and itching in individuals with LSC.

Use of Corticosteroids

• Clobetasol: It is a high-potency topical corticosteroid that is often used for the short-term treatment of moderate to severe inflammation and itching associated with LSC.  It exerts anti-inflammatory, immunosuppressive, and vasoconstrictive effects by inhibiting the release of inflammatory mediators and suppressing the immune response in the skin.  

• Betamethasone Dipropionate: Betamethasone dipropionate is another high-potency topical corticosteroid that is frequently used in the treatment of inflammatory skin conditions, including LSC.  It works by exerting potent anti-inflammatory and immunosuppressive effects, reducing itching, erythema, and skin thickening in affected areas.  

• Triamcinolone acetonide: It is a mid- to high-potency topical corticosteroid commonly used in the treatment of inflammatory skin conditions, including LSC.  It helps reduce inflammation, itching, and skin thickening by suppressing the immune response and inhibiting the release of inflammatory mediators in the skin

Use of Antipruritic agents

• Diphenhydramine: Diphenhydramine is a first-generation antihistamine with sedative properties that is commonly used to relieve itching and allergic symptoms. It works by blocking the action of histamine, a chemical mediator involved in the inflammatory response and itching.  

• Hydroxyzine: Hydroxyzine is another first-generation antihistamine with sedative properties that is frequently used to relieve itching and allergic symptoms.

Use of Immunosuppressant Agent

• Tacrolimus ointment: It is a topical immunosuppressant medication that is commonly used in the treatment of inflammatory skin conditions, including Lichen Simplex Chronicus (LSC).  Tacrolimus belongs to a class of medications known as calcineurin inhibitors, and it works by inhibiting T-cell activation and the release of inflammatory cytokines, thereby reducing inflammation and itching in the skin. 

Use of Immune Modulator

• Pimecrolimus: It works by inhibiting the activation of T-cells and the release of inflammatory cytokines, thereby reducing inflammation in the skin. This can help alleviate itching, erythema, and skin thickening associated with LSC. 

use-of-intervention-with-a-procedure-in-treating-lichen-simplex-chronicus

• Cryotherapy: Cryotherapy involves the application of extreme cold to the affected skin using liquid nitrogen or another cryogen. Cryotherapy may be used to freeze and destroy thickened areas of skin in LSC, promoting regeneration of healthy skin.  
• Electrocautery: Electrocautery, or electrocoagulation, uses a high-frequency electrical current to selectively destroy tissue. It may be used to remove thickened or lichenified areas of skin in LSC, particularly in cases where other treatments have failed or in the presence of secondary infections. 
• Excisional Surgery: Excisional surgery involves the surgical removal of thickened or lichenified skin lesions in LSC. This procedure may be considered in cases where conservative treatments have been ineffective or when there are complications such as secondary infections.  

use-of-phases-in-managing-lichen-simplex-chronicus

• Assessment and Diagnosis: The initial phase involves a comprehensive assessment to establish the diagnosis of LSC and identify any underlying triggers or contributing factors.  
• Acute Symptom Management: In the acute phase of LSC management, the focus is on alleviating itching, reducing inflammation, and preventing further skin damage.  
• Long-Term Maintenance: Once acute symptoms are controlled, the emphasis shifts to long-term maintenance therapy aimed at preventing relapses and minimizing the risk of recurrence. 
• Behavioral Therapy and Education: Behavioral therapy, such as habit reversal therapy, cognitive-behavioral therapy (CBT), or relaxation techniques, plays a crucial role in managing LSC.

Medication

Future Trends

Media Gallary

References

Lichen simplex chronicus- DermNet (dermnetnz) 

Lichen Simplex Chronicus – StatPearls – NCBI Bookshelf (nih.gov)