What Is Lichenification and How Can I Treat It?

Medically reviewed by Cynthia Cobb, DNP, APRN on October 24, 2017Written by Corinne O'Keefe Osborn on October 24, 2017

What is lichenification?

Lichenification is when your skin becomes thick and leathery as a result of constant scratching. When you continually scratch an area of skin for a prolonged period of time, your skin cells begin to grow. This leads to a thickening of the skin and an exaggeration of normal skin markings — such as cracks, wrinkles, or scales — which gives your skin a leathery or bark-like appearance.

Lichen simplex chronicus, which is also known as neurodermatitis, is a patch of skin that’s been lichenificated. Lichen simplex isn’t a primary condition or disease, but rather a result of some underlying cause. The underlying cause is typically severe, chronic (long-term) itching, but is sometimes related to severe anxiety or obsessive-compulsive behavior.

Pictures of lichenification

Symptoms

Lichen simplex involves an extremely itchy patch of skin that you can’t help scratching. The itchiness can be nonstop or intermittent. Scratching may become so habitual that you even do it in your sleep.

Symptoms include:

  • a chronically itchy patch or patches of skin
  • thick, leathery skin
  • scaly, bark-like skin
  • raised patch or patches of skin that are red or dark

Causes

People scratch for many reasons. It may begin with a small irritation of the skin, like a bug bite. Or it may be the result of a chronic skin condition. Either way, lichenification can get progressively worse without treatment.

Lichenification results from a terrible cycle of itching and scratching, wherein scratching makes the itchiness worse. This causes you to scratch more. And the more you scratch, the worse your lichen simplex will get. Check out some tips for getting rid of the itch.

Conditions that lead to lichenification include:

Diagnosis

Your doctor can usually diagnose lichen simplex by performing a physical examination. They’ll look for the characteristic signs and symptoms, such as skin thickening and a leathery texture.

If you and your doctor don’t know what’s causing the lichenification, or the itchiness, some further tests may be necessary. This may include a skin biopsy or a neurological exam.

Treatment

There are a variety of treatments used for lichenification. These include the following:

Fluticasone propionate

Traditionally, treatment approaches for lichenification have focused on treating itchiness and reducing scratching by addressing the underlying cause of the problem, such as atopic dermatitis or psoriasis.

But recent research published in ACTA Dermato-Venerologica suggests that there’s a quicker way to treat lichenification effectively.

The 2014 journal article reviewed three atopic dermatitis studies that were similar in design. Two of the studies involved the topical application of fluticasone propionate cream or ointment, one to two times daily. The third was a placebo control trial.

All the study participants applying fluticasone propionate saw improvements to their lichenification within the first week. After four weeks, more than 80 percent of participants showed no, very mild, or mild lichenification.

These results are significant and suggest that the best way to treat moderate to severe lichenification is with a topical fluticasone propionate ointment. You’ll need a doctor’s prescription for fluticasone propionate.

Other prescription drugs

Other prescription drugs used to treat lichenification include:

  • corticosteroid creams
  • corticosteroid injections directly into the affected skin
  • prescription-strength allergy drugs and antihistamines
  • anti-anxiety medications

Over-the-counter (OTC) treatments

You may be able to effectively treat lichenified skin using OTC products. These include:

  • corticosteroid creams, such as Cortizone 10
  • anti-itch creams
  • antihistamines like Benadryl
  • soothing moisturizers
  • camphor and menthol topical creams, such as Men-Phor and Sarna

Therapies

Some therapies may be effective in resolving itching and lichenification due to underlying conditions. These include:

Home remedies

There are a number of things you can try at home. These home remedies are aimed to either keep common causes of itching at bay or prevent you from scratching.

Scratching makes lichenification worse and increases itchiness. The best thing you can do is force yourself to break the cycle.

  • Try wearing gloves while you sleep. A thin pair of gloves, like those meant for moisturizing, may prevent you from causing damage while you’re asleep.
  • Cover affected patches of skin. Use Band-Aids, bandages, gauze dressings, or anything else that will make it more difficult for you to scratch.
  • Keep your nails extra short. Short, smooth nails will do less damage. Try using a nail file to round out the corners of your nails.
  • Apply cool, wet compresses. This may soothe skin and help medicated creams soak into the skin more effectively. You can make your own cool compress at home.
  • Use gentle, fragrance-free products. Try gentle perfume-free soaps, unscented moisturizers, and fragrance- and dye-free laundry detergents.
  • Take warm oatmeal baths. Make sure your baths are warm but not hot, since hot water can dry out skin. Add uncooked oatmeal or colloidal oatmeal powder. Here’s how to make your own oatmeal bath.
  • Avoid anything that triggers itchiness, including stress. Here are some tips for reducing stress.

Outlook

Lichenification of the skin can be very uncomfortable. The itchiness might be intense, but scratching will only make it worse. Overall, the outlook is good and the condition is often temporary. Research suggests that lichenification can be treated quickly and effectively with a topical fluticasone propionate ointment.

Treating the underlying cause may be necessary to prevent future recurrences. Talk to your doctor about developing a treatment plan. In the meantime, there are many things you can do at home to treat the symptoms of lichenification and prevent it from getting worse.

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