Information from Libby Edwards, MD - Mid-Charlotte Dermatology & Research

LICHEN SIMPLEX CHRONICUS

Lichen simplex chronicus (LSC), atopic dermatitis, eczema, neurodermatitis, and dermatitis are different names for the same problem. LSC is an itchy skin rash that occurs in people like you who have sensitive skin. Normal mild irritations of daily living such as soap, water, perspiration, stress, and rubbing from clothes cause irritation. Although some people feel irritation as soreness, people with LSC feel irritation as an itch. Then, scratching causes more irritation and makes the skin itch even more, until the rubbing and scratching actually turns into LSC.

Because people with LSC have skin that is easily irritated, there is no cure for LSC. However, cortisone creams and very careful skin care to minimize irritation usually control the problem.

Treatment includes:

1. A very important part of the treatment is careful skin care to avoid irritation. Washing the skin is the most common irritation for skin. Washing dissolves the natural oils in the skin and allows tiny, invisible cracks that itch. Therefore, hot water and harsh soaps should be avoided. Usually clear water suffices, with no soap.

Rough fabric and tight clothes can increase itching. Overheating also makes itching worse, and sweat can be very irritating, so patients with LSC should stay as cool as is comfortable. Panty liners are irritating for many women as well.

Douches, perfumes, deodorants, and medications other than those prescribed by a health care provider should be avoided because of the possibility of allergy or irritation.

2. Cortisone (steroid) ointment or cream is extremely important in the treatment of LSC. This medication helps to soothe irritation and inflammation as well as to help the itch. Cortisones are applied very sparingly (more does not work better than less) and they are applied only to the areas of scaling, redness, or itching. The cortisone should be used until the skin feels normal to the touch and then often it can be discontinued. Although cortisones are useful in the treatment of LSC, simply applying the cortisone without attention to avoiding excess washing and irritation often does not clear LSC.

3. Medication at night to sleep without scratching is important. As long as the skin is being scratched or rubbed, it will not heal. Night-time sedation with an antihistamine such as Benadryl (diphenhydramine), Atarax (hydroxyzine), or amitriptyline (Elavil) induces sleep at night without scratching. As the itching stops, this medication can be discontinued

4. Sometimes, when there is weeping or crusting of the skin or a vaginal discharge, infection is present, so that antibiotics or medication for yeast is important in some patients.

The treatment of eczema is a lot of work. It is important to follow these instructions carefully until the itching has disappeared, and then gradually decrease the frequency of cortisone use and nighttime medication. Flares of skin disease from stress and new irritations occur in many people.