Lichenification

What is Lichenification of skin?

Definition: Skin ‘Lichenification’ occurs when there is chronic irritation or itching of the skin that leads to thickening of the skin at the site due to repeated scratching ^{(1, 2, 3, 4)}. It looks thick and leathery with prominent skin cracks and scales.

Picture 1 : Image shows an area on the thigh with lichen simplex chronicus. Thickened skin with prominent features can be appreciated in this Lichenification image.

How does Lichenification occur?

Repeated scratching on the area of irritation actually causes another inflammatory process resulting in hypertrophy (increased growth) of the outer layer of skin (epidermis). This causes the thickened area to be with prominent markings leading to its appearance as leathery ⁽²⁾.

It may be reddish or pinkish in fair skinned people while in dark skinned they appear darker than the surrounding area ^{(5, 6)}.

Cause

Thickening occurs mainly due to repeated scratching. The cause for this is understood as an itch-scratch cycle in which itching leads to scratching and scratching leads to more of itching and further on ⁽⁷⁾.

Lichenification is considered as a secondary skin lesion ⁽⁸⁾.

What are the conditions in which Lichenification occurs?

It can be seen in conditions leading to repeated itching. They include ⁽¹⁾

• Eczema including atopic dermatitis
• Contact dermatitis
• Dry skin
• Psoriasis
• Stress and anxiety disorders
• Bug bites

Symptoms of Lichenification

Lichenification symptoms may vary from one person to another. In general they may include ⁽⁹⁾

• Skin patches which are dry and/or scaly
• Colour change from the surrounding skin.
• Appear leathery and thick with prominent scales or skin cracks.
• Plaques may be formed with definitive shape.

Lichen simplex chronicus

This is a condition in which Lichenification occurs due to uncontrollable itching in the same area of the body ^{(10, 11)} that may be associated with itch-scratch cycle, atopy or stress.

Picture 2: Lichen simplex chronicus on dorsum of hand.

Diagnosis

A careful examination of the lesion followed by investigations to exclude fungal disorders such as tinea would help in pinpointing the diagnosis ^{(9, 11)}.

Home care

Few matters if taken care of can help the people who suffer from the difficulty of Lichenification ^{(1, 12)}.

• Reduce stress by involving in stress relaxation techniques such as meditation
• Reduce the size of nails frequently to avoid damage to the skin and secondary bacterial infections.
• Wear loose clothes to prevent itching.
• Apply bandages or coverings to break the cycle of itch-scratch.
• Wet compress application to soothen the area.

Treatment : How to get rid of

Treatment is targeted towards reducing the inflammation and thus itching.

• Topical corticosteroids
• Immune suppressants such as tacrolimus, has been found to be effective.
• Topical antihistamines
• Systemic antihistamines
• Behavioural education to reduce scratching of the area.
• Topical moisturizers or emollients.
• Anti-depressants or anti-anxiety drugs might be required occasionally.
• Antibiotics may be required if secondary bacterial infection is seen^{(9, 12)}.

Summary

Lichenification though is very uncomfortable; the outlook of the condition is good if appropriate measures are followed. Treatment of the underlying cause with adequate medications and general care at home can provide an improved quality of life with an almost complete resolution of the lesions.

Images of Lichenification

Image 3: Excessive scratch marks with Lichenification. Also note the colour of lesion in a light skinned person. source : healthline.com

 

Image 4: Lichenification in a dark skinned person.

 

Picture 5: Eczema on popliteal fossa (Behind the knees) with Lichenification.

References:

1. www.healthline.com/health/lichenification
2. www.medicinenet.com/script/main/art.asp?articlekey=10131
3. medlineplus.gov/ency/article/003251.htm
4. https://www.merriam-webster.com/medical/lichenification
5. Shaw TE, Currie GP, Koudelka CW, Simpson EL. J Invest Dermatol. 2011;131:67-73.
6. Fondation Dermatite Atopique. Accessed online on 4/12/17 at
7. www.fondation-dermatite-atopique.org/en/patients-parents-family-space/news/atopic-dermatitis-and-dark-skin.
8. www.blackwellreference.com/public/tocnode?id=g9781405161695_chunk_g978140516169523_ss277
9. www.dermweb.com/morphology/lichenification1.htm
10. www.merckmanuals.com/professional/dermatologic-disorders/dermatitis/lichen-simplex-chronicus
11. Lynch, Peter J. (2004-01-01).  Dermatologic Therapy. 17 (1): 8–19.
12. emedicine.medscape.com/article/1123423-overview#a4
13. www.thehealthyapron.com/lichenification-definition-treatment
14. atopicdermatitis.net/thickened-skin-lichenification/