Lichen simplex chronicus is a skin disorder that is not dangerous, but very annoying and not well understood. Recent research has shown that the quality of life of people suffering with lichen simplex, or neurodermatitis, is lower than that of patients with psoriasis. What begins as a simple itch on the skin becomes a chronically irritated patch of thickened, reddened skin that is intensely itchy–and worse the more you scratch it. The itchiness usually comes and goes, and the urge to scratch can persist even overnight while you sleep. How can you get it to go away? The key seems to be to interrupt the itch-scratch cycle, typically by addressing any underlying conditions, and by suppressing the itchiness.
Address underlying conditions
For this step, you will need to see a doctor. You need to eliminate possibilities such as eczema and psoriasis, as well as rare, but serious diseases, such as liver failure and cancer. If the skin has become infected, you’ll need antibiotics.
Next, you will want to make sure that you address any excessive stress or worry you may be facing. This is sometimes easier said than done. Any treatments effective for stress, worry, or depression will help reduce itching due to lichen simplex chronicus. This includes self help books, talk therapy, exercise, mindfulness, and medication, as well as straightening out (or learning to cope with) any sticky life issues you may be facing.
Suppressing the itchiness
There are various approaches to suppressing the itchiness of neurodermatitis. Unfortunately, treatment of neurodermatitis has not been well explored in clinical trials and is based on expert opinion. What is clear is that most treatments for lichen simplex chronicus are only partially effective, but do reduce symptoms somewhat in some people. Here are some things to try:
1) Watch what you eat. Caffeine, alcohol, and spices worsen symptoms in some people. If you notice this is the case, avoid the offending food or substance.
2) Rethink bedtime. Loose, comfortable pajamas and smooth sheets are a must. Use a moisturizer if your skin tends to be dry. Your doctor can prescribe a nonaddictive sedative such as Atarax. You may want to try wearing mits or gloves if you scratch in your sleep.
3) Know the ingredients to a soothing bath. Colloidal oatmeal baths help some people. Hot water can trigger itching, so a cooler bath may be more comfortable. After bathing, remember to moisturize.
4) Choose comfortable clothing. Think loose, soft, smooth, breathable clothing. Fabrics such as cotton and silk are easier on the skin than something like wool or polyester. Anything that rubs or puts pressure on the skin could trigger or worsen itching. A classic trigger is pressure from bra straps, clips, seams, or hooks. A slip on bra, like a sports bra, might be helpful in this situation.
Pressure can also be caused by things carried on the body like backpacks or purse straps.
5) Try over the counter medication. Antihistamines like cetirizine (brand name: Zyrtec) or diphenhydramine (brand name: Benadryl), when taken by mouth, can sometimes be helpful with itching, particularly if it is caused by underlying eczema.
Damage control
Complications of neurodermatitis include infection, worsening itching, and medication side effects. Here are some things not to do.
1) Don’t scratch. Even rubbing the area will make it worse, although rubbing is less likely to lead to infection than digging holes in your skin with your nails.
Try these alternatives to scratching:
a) apply ice, lotion, refrigerated lotion, or Menthol/camphor lotion (Sarna) to the area or someplace else as a distraction.
b) drink a glass of water.
c) go for a walk.
2) Don’t use topical antihistamines (those applied to the skin instead of taken by mouth), topical numbing agents (lidocaine, benzocaine, etc.), or lanolin as these can cause allergies and other itchy skin reactions.
3) Don’t use topical steroids unless directed by a doctor. Steroid creams can have nasty long term side effects if used long term and often are not very effective for itching from neurodermatitis alone. They can be very helpful for eczema, however.
There are prescription treatments available. However, some may not be any more effective than the measures above, and some may have serious side effects. See your doctor again if:
1) You’re not getting better after 8-12 weeks of consistent treatment.
2) The area is getting more painful through more of the day.
3) The area is getting a lot bigger or thicker.
4) The area is not getting better and changing in appearance.
5) The area is persistently red, hot to the touch, weeping fluid or pus.
6) You are having worsening stress, to the point of feeling hopeless or suicidal.
Reference:
Moses, Scott. “Family Practice Notebook.” Lichen Simplex Chronicus. Family Practice Notebook, LLC, 19 Aug. 2013. Web. 18 Sept. 2013