Lichen simplex, also called neurodermatitis, is a common skin problem. It generally affects adults, and may result in one, or many itchy patches.
Lichen simplex is a type of dermatitis, and is usually the result of repeated rubbing or scratching. The stimulus to scratch may be unrecognized, perhaps a mosquito bite, stress, or simply a nervous habit.
The result is a very itchy patch of skin, often located on the nape of the neck, the scalp, the shoulder, the wrist, or the ankle. The genitals are less common sites.
The affected skin is thickened, often appearing as a group of small firm papules (bumps). The skin markings are more visible, and the hairs are often broken-off. The colour may be darker or sometimes paler than the surrounding skin.
Lichen simplex tends to be very persistent, and readily recurs despite often initially effective treatment.
This is most important but will need a lot of will-power! Steroid creams prescribed by your doctor will help. Apply moisturizers or a cold flannel whenever you feel the need to scratch. Pat instead of rubbing. Cut your nails short and use the pulp of your fingers.
As lichen simplex seldom responds to mild topical steroid preparations, potent topical steroids are usually needed. Apply a thin layer of the cream to the affected areas at night. Continue until the patch has flattened with the normal skin.
Your doctor or dermatologist may suggest occluding the worst patches by taping them with a plastic cling film wrap at night-time. Do not do this for more than a few days without checking first with your doctor.
Note: this treatment may not be suitable for the face, genitals or body folds, as strong steroid creams can cause skin thinning.
Treatment should then be continued with a weaker topical steroid if the itch continues to be bothersome.
- Coal tar preparations can work well to lessen the itching, without any risk of skin thinning.
- Moisturisers should be applied liberally and often, to smooth the skin and reduce itch.
- Avoid soap: try bath oils or soap substitutes.
- Antihistamine pills can lessen itch. They are best taken at night.
- Steroid injections into the patches may be recommended by your dermatologist.
- Phototherapy (ultraviolet light treatment) is worthwhile for those with widespread neurodermatitis.
- Oral corticosteroids, methotrexate, azathioprine or ciclosporin are sometimes necessary for severe widespread lichen simplex.
- There are reports of benefit from selective serotonin reuptake inhibitor antidepressants and gabapentin.