ichen Simplex Chronicus — A chronic pruritic skin disorder characterized by well-demarcated, thickened, lichenified plaques caused by persistent scratching or rubbing
Etiology & Pathogenesis
- Initiated by pruritus of various causes, followed by habitual scratching.
- Itch–scratch cycle leads to epidermal hyperplasia → lichenification.
- Often associated with:
- Atopy
- Anxiety/stress
- Psychological factors
- Other dermatoses (eczema, psoriasis, insect bites)
Risk Factors
- Emotional stress or psychiatric conditions.
- Atopic individuals.
- Tight clothing, friction, heat exposure.
- Chronic dry skin.
Clinical presentation
- Localized lichenified plaque with exaggerated skin markings.
- Color: skin-colored to hyperpigmented.
- Very itchy, often worse at night.
- Common sites:
- Neck and nape
- Ankles
- Dorsum of hands/feet
- Scalp
- Genital and perianal region
- Extensor surfaces
- Secondary changes may include excoriations, hyperpigmentation, or scaling.
Investigations
- Generally clinical based on appearance and history.
- Biopsy only if diagnosis uncertain (shows epidermal hyperplasia, hyperkeratosis, acanthosis).
- Consider evaluating underlying psychiatric or dermatologic conditions.
- Differentiate from psoriasis, tinea, lichen planus, atopic dermatitis.
Management
Goals: break the itch–scratch cycle and reduce inflammation.
- Behavioral Management
- Patient education, avoid scratching.
- Keep nails short.
- Stress reduction techniques.
- Topical Therapy
- High-potency topical corticosteroids (e.g., clobetasol proprionate 0.05%)
- Calcineurin inhibitors (tacrolimus 0.1%, pimecrolimus 0.1%) alternative for sensitive areas.
- Systemic Therapy
- Antihistamines (especially at night for itching).
- In severe cases: short course systemic steroids or sedative anxiolytics.
- Adjunctive Measures
- Emollients to restore skin barrier.
- Occlusive dressings to reduce scratching.
- For refractory cases: phototherapy, intralesional corticosteroids.
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