like appearance (plaques). Lichen simplex chroni-
cus sometimes develops in areas of the skin that
have previously had irritation, such as from DER-
MATITISor abrasive injury, or frequently irritated,
such as from clothing that rubs or constricts. Stress
and strong emotional responses exacerbate the
rash and the itching. The condition appears more
common in people who have DEPRESSIONor anxi-
ety, hence the former term, neurodermatitis, for
the condition. Most often, however, there is no
clear cause for the condition.
Symptoms and Diagnostic Path
The rash of lichen simplex chronicus begins with
small reddened areas (macules) that itch, com-
monly forming on the neck and the inner surfaces
of the arms and legs. Most people who have
lichen simplex chronicus describe the itching as
intense, such that they are unable to stop scratch-
ing. With scratching, the rash becomes more
extensive. Many people find the itching more pro-
nounced at night before sleep, creating difficulty
falling asleep or staying asleep. The dermatologist
typically diagnoses lichen simplex chronicus on
the presentation of these symptoms, though may
choose to biopsy questionable lesions to confirm
the diagnosis.
Treatment Options and Outlook
Treatment targets relieving the symptoms, prima-
rily the itching. The dermatologist may prescribe
oral ANTIHISTAMINE MEDICATIONS and topical CORTI-
COSTEROID MEDICATIONS, which work together to
mitigate the IMMUNE SYSTEM’s response to the per-
sistent irritation scratching causes. Antihistamine
medications are especially helpful at bedtime,
when many people find the itching most intense,
as they tend to cause drowsiness. Some people
benefit from ANTIANXIETY MEDICATIONS. Methods
such as VISUALIZATION, BIOFEEDBACK, and ACUPUNC-
TUREmay help. Mild to moderate lichen simplex
chronicus generally heals without residual effects,
though more severe manifestations may leave
scarring and altered pigmentation (either lighter
or darker patches of skin in the sites of the healed
plaques).Risk Factors and Preventive Measures
The causes of lichen simplex chronicus remain
elusive. Dermatologists disagree on whether the
rash or the itching appears first, though the end
result is that the rash itches and continued
scratching perpetuates the rash. The most impor-
tant factor is to avoid scratching, as persistent
scratching causes other damage to the skin that
increases the risk for INFECTION and scarring. In
many people, episodes follow stressful experi-
ences. Stress management techniques and relax-
ation methods provide other means for diffusing
the physiologic effects of stress.
See also GENERALIZED ANXIETY DISORDER (GAD);
ICHTHYOSIS; KERATINOCYTE; LESION; LICHEN PLANUS;
MACULE; PLAQUE, SKIN; PRURITUS; PSORIASIS; SCAR;
STRESS AND STRESS MANAGEMENT.174 The Integumentary System