Neurodermatitis

Lichen simplex (also called lichen simplex chronicus) is a chronic skin condition triggered by repetitive scratching or rubbing, often starting with an itch.

An irritant initially causes the person to scratch the affected area, and the skin thickens after contact. The itch typically begins during a stressful period and lasts after the stress subsides.

Lichen simplex is more common in adults, particularly between the ages of 30 and 50, and is more frequently seen in women. Although rare in children, it can develop in those with chronic itchy conditions such as atopic eczema.

Known triggers of lichen simplex include:

• Underlying skin conditions (e.g. eczema, fungal infections)

• Emotional stress or anxiety

• Tight or irritating clothing, especially synthetic fabrics or wool

• Heat and sweating

• Insect bites

• Dry skin

• Rarely, neurological causes such as nerve injury or stroke

Symptoms

• Itchy patch: The condition typically begins with one or two intensely itchy patches of skin. These can occur anywhere but are most commonly found on the arms, legs, back of the neck, genitals (such as the scrotum or vulva), or around the anus.

• Distinct from eczema or psoriasis: Unlike eczema or psoriasis, which often present with widespread rashes, lichen simplex usually affects isolated areas.

• Chronic itching: The itch may come and go but can become very intense, particularly during periods of rest or at night. This can lead to disrupted sleep.

• Skin changes due to scratching:

  • The itchy patch may become red or violet in colour.

  • Ongoing scratching and rubbing can lead to thickening and hardening of the skin (lichenification), which may become leathery and brown or grey in appearance.

  • In some cases, the area may become painful or tender.

• Scalp involvement: When it appears on the scalp, persistent scratching can cause hair loss in the affected area.

• Infection risk: Repeated scratching may cause breaks in the skin, increasing the risk of infection. Signs of infection may include:

  • Yellow or honey-coloured crusts

  • Fluid or pus-filled spots

  • Increased redness, warmth, or swelling

What can I do?

There are several things you can do at home to help manage lichen simplex. Moisturising the affected skin regularly with an unperfumed emollient is essential to reduce dryness and itchiness.

Scratching the area can make the condition worse, so it’s important to avoid doing so wherever possible. Keeping your nails short and covering the area with loose, soft clothing or a protective dressing may help.

Applying a cool damp cloth to the skin or soaking the area in lukewarm water for a few minutes before applying any steroid treatment can improve absorption and ease symptoms.

Stress is also a known trigger, so practising stress management techniques like relaxation exercises may be beneficial. You should also avoid common irritants such as wool, synthetic fabrics, fragranced soaps, or harsh detergents, which can worsen the itch.

Should I seek medical care?

If you think you may have lichen simplex (neurodermatitis), it is important to see your GP. This condition rarely improves without appropriate treatment. Your doctor can help confirm the diagnosis and rule out other possible skin conditions.

In some cases, patch testing may be recommended to check for possible contact allergies that could be contributing to the problem. Identifying and avoiding these triggers can help prevent further flare-ups and improve your symptoms. Early treatment can also reduce the risk of complications such as infection, scarring, or persistent thickening of the skin.

Treatment

Lichen simplex is typically treated with topical creams to reduce inflammation and ease itching. These may include corticosteroid creams, which help calm the skin and reduce thickening, or antihistamines to manage the itch, especially at night.

Other options such as doxepin cream (a topical antihistamine) or capsaicin cream (derived from chilli peppers) may be used to reduce nerve-related itch. It’s important to follow the advice of your healthcare provider on how and when to apply these treatments.

In some cases, treatment may be combined with moisturisers and protective dressings to enhance effectiveness and prevent further scratching.