Lichenification - Causes, Symptoms, Diagnosis, and Treatment

What Is Lichenification?

Lichenification is a skin condition causing the skin to become thick and leathery. It generally results from constant scratching or rubbing of the skin. Lichenification can be divided into primary and secondary types. The primary lichenification represents lichen simplex chronicus, also known as neurodermatitis circumscripta. Secondary lichenification arises in conditions such as psoriasiform dermatitis (skin cells build up to form scales and itchy, dry patches), xerosis (dry skin), atopic dermatitis (eczema), infective eczematous dermatitis (acute eczematous eruptions), pityriasis, psoriasis, porokeratosis (keratotic papules on unexposed skin), vegetative growths, obsessive-compulsive disorders, and anxiety. The lichenification lesion starts as hyperpigmentation on a flat skin surface.

Which Areas of the Body Does Lichenification Affect?

Due to the provocative factor of chronic rubbing, lichenification often occurs in easily accessible sites such as the vulva, thighs, lower legs, nape of the neck, wrists, hands, forearms, waist, scrotum, and dorsa of feet. Inevitable issues are known to occur in the postauricular area, lower eyelids, axillae, and popliteal fossae. Diffuse types of lichenification involve the neck, face, chest, abdomen, arms, flanks, forearms, lower legs, and thighs. The lesion presents as ill-defined plaques varying from numerous flat-topped papules, hyperpigmented patches, and indurated plaques that present symmetrically with the involvement of extremities.

Lichen simplex chronicles or neurodermatitis appear as a patch of skin that has been lichenified. The underlying cause is chronic (long-term) itching but can sometimes be related to trauma to the skin, severe anxiety, or obsessive-compulsive behavior such as scratching or rubbing the skin for a long time.

What Causes Lichenification?

Lichenification generally results from the constant rubbing or scratching of the skin. Chronic irritation arising as a result of conditions such as eczema can cause lichenified skin. People scratch their bodies for many reasons. It usually begins with a small irritation of the skin, such as a bug bite. Or it may be the result of a chronic skin condition.

Lichenification results from a cycle of itching and scratching, where the scratching makes the itchiness worse. This provokes the individual to scratch more. Also, the more scratching occurs, the worse lichen simplex gets. Itching, rubbing, and scratching of the skin are other causes of lichenification.

Various conditions resulting in lichenification include:

• Contact dermatitis.

• Atopic dermatitis.

• Eczema.

• Bug bites.

• Psoriasis.

• Dry skin.

• Anxiety disorders.

• Stress.

• Skin trauma.

• Obsessive-compulsive disorder.

What Are the Symptoms of Lichenification?

Lichen simplex arises on the skin where rubbing is constant or related to skin trauma. However, it generally involves an extremely itchy patch of skin that cannot be stopped from scratching. The itchiness or rubbing can be constant or intermittent. Scratching can become habitual that is done even during sleep. The symptoms include-

• Thick or leathery skin.

• A chronically itchy patch or itchy patches of the skin.

• Scaly or bark-like skin.

• A raised red or dark patch or patches of skin.

How Is Lichenification Diagnosed?

Diagnosis of lichen simplex can be made by a physical examination. The physician looks for the characteristic signs and symptoms, such as skin thickening and a leathery texture. The physician rules out the causes of lichenification or itchiness. This may include a skin biopsy or a neurological examination.

How to Treat Lichenification?

A variety of methods is used to treat lichenification. These include the following:

1. Fluticasone Propionate: The treatment approaches for lichenification are focused on treating itchiness and reducing scratching by dealing with the underlying cause of the problem, such as atopic dermatitis or psoriasis. However, recent research indicates that there is a quicker way to treat lichenification effectively. This includes the topical application of fluticasone propionate cream or ointment one to two times a day. The results of using Fluticasone propionate are significant and suggest that the best way to treat moderate to severe lichenification is with a topical Fluticasone propionate ointment, which is available only on a doctor's prescription. Other prescription drugs used to treat lichenification include:

• Anti-anxiety medications.

• Corticosteroid creams.

• Prescription-strength allergy drugs and antihistamines.

• Corticosteroid injections are directly given to the affected skin.

2. Over-the-counter (OTC) Treatments: Lichenified skin can be treated by using OTC products effectively. These include-

• Anti-itch creams.

• Corticosteroid creams.

• Soothing moisturizers.

• Camphor and menthol topical creams.

• Antihistamines like Benadryl.

3. Therapies: Effective therapies can help in resolving itching and lichenification due to underlying conditions. These include-

• Acupressure.

• Light therapy.

• Psychotherapy.

• Acupuncture.

4. Home Remedies: Home remedies to treat lichenification are intended to either prevent the common causes of itching or prevent scratching. Scratching worsens lichenification and increases itchiness.

• To avoid scratching or rubbing while sleeping, try to wear gloves. A thin pair of gloves helps moisturize and prevents damage during sleep.

• The affected patches of skin should be covered with Use bandages, gauze dressings, or anything that will prevent scratching.

• Keeping the nails short and smooth will do less damage. Filing the nails with a nail file can round out the corners of the nails.

• To soothe the skin, apply a wet compress. Medicated creams soak into the skin more effectively.

• The use of gentle and fragrance-free products can help in healing. Try soft perfume-free soaps, unscented moisturizers, and fragrance-free laundry detergents.

• Take warm baths and make sure the baths are warm and not hot, as hot water can dry skin.

• Try to avoid things that trigger itchiness, including stress.

Conclusion

Lichenification is a thickening of the skin with variable scaling that arises secondary to repetitive scratching or rubbing. It is not a primary process. Instead, an individual senses pruritus in a specific area of skin (with or without underlying pathology) and causes mechanical trauma to the point of lichenification. It can be best treated with topical application of Fluticasone propionate. Other treatment strategies include corticosteroid creams, anti-anxiety medications, and antihistamines.