Author: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1997. Updated July 2014.
Lichen simplex is a localised area of chronic, lichenified eczema/dermatitis. There may be a single or multiple plaques. It is also called neurodermatitis.
Although the mechanism is not understood, lichen simplex follows repetitive scratching and rubbing, which arises because of chronic localised itch. The primary itch can be due to:
Itch due to neuropathy appears to be due to hyperexcitable sensory nerve fibres following nerve injury or entrapment.
Lichen simplex occurs in adult males and females. It is unusual in children. It is more common in people with anxiety and/or obsessive compulsive disorder.
A solitary plaque of lichen simplex is circumscribed, somewhat linear or oval in shape, and markedly thickened. It is intensely itchy. Other features may include:
Lichen simplex is often solitary and unilateral, usually affecting the patient’s dominant side. Multiple plaques can also arise, with bilateral and symmetrical or asymmetrical distribution. The location of lichen simplex is not random, as some body sites are particularly commonly affected. These include:
Clinical appearance is generally typical. At times, it may be helpful to do some investigations. These would include:
In the absence of known underlying skin problem or infection, consider neuropathy. Is there a history of spinal injury, disease or symptoms? In severe cases, the following tests may be performed (although they are often unhelpful):
It is important to understand that the itchy patch of skin is, at least in part, due to scratching and rubbing. Treatment needs to address the symptoms and any underlying cause.
Treatment of the lichen simplex may include:
The primary condition needs treating; for example:
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