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Lichenification

What Is It, Causes, Diagnosis, Treatment, and More

Author: Jessica Rivas

Editors: Ahaana Singh, Lisa Miklush, PhD, RN, CNS

Illustrator: Jillian Dunbar


What is lichenification?

Lichenification is a secondary skin lesion that is characterized by hyperpigmentation, thickening of the skin and exaggerated skin lines. These skin lesions usually appear from constant scratching or rubbing in areas, such as the elbows. 

Usually the lesion begins with hyperpigmentation, or the darkening of a patch of skin. This is often followed by the development of small papules, which are small, raised bumps on the skin. Finally, thickening of the skin can occur, which results in the characteristic sign of exaggerated skin lines or markings.

What causes lichenification?

Lichenification may be further classified as primary or secondary, depending on its cause. Primary lichenification is caused by constant itching or rubbing of the skin due to lichen simplex chronicus, also known as neurodermatitis. This condition is characterized by uncontrollable and excessive itching or rubbing of the skin, often with no definitive source of itchiness.

Secondary lichenification occurs when an underlying disease or condition causes excessive itching and, in some cases, leads to lichen simplex chronicus. Some skin conditions that may result in secondary lichenification include atopic dermatitis, eczema, xerosis, psoriasis, dermatophyte infections, or bug bites. In addition, some psychological conditions, such as severe anxiety or obsessive-compulsive behavior disorder, may lead to secondary lichenification.

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Is lichenification contagious?

Lichenification is not contagious nor is it life threatening. 

How do you diagnose lichenification?

If an individual finds themselves uncontrollably scratching, they should seek out medical advice. Some signs that may indicate a need for medical advice include constant scratching that interferes with daily routine or sleep, as well as the reddening and increasing pain of the associated area of skin. In some cases, individuals may also experience fevers if the area has become infected. 

Accordingly, providers will likely examine the skin and affected areas to determine if the lesions are related to scratching or rubbing. If the cause is unclear or an underlying systemic disorder is suspected, a skin biopsy may be required. In some cases, psychological evaluation may also be necessary.

How do you treat lichenification?

Treatment for lichenification varies depending on the cause and the severity of the lesion. The main goals of treatment are to control the itching and scratching, as well as address any underlying causes.

Topical steroids are often suggested. Although over-the-counter corticoid medication will usually resolve the problem, in cases of persistent itchiness, providers may prescribe more potent topical steroids, such as fluticasone propionate. If the lesions are large, corticosteroid injections may also help them heal faster. Depending on the cause, antihistamines can also be prescribed to help relieve the itching. In some cases, light therapy can help treat lichenification by exposing the skin to certain wavelengths of light in order to reduce the itchiness and accelerate the skin's healing process. 

For itching related to stress, anxiety, or obsessive-compulsive behavior disorders, anxiety medication may be beneficial. Psychotherapy (e.g. cognitive behavioral therapy, or CBT) may also be recommended. 

At home treatment and prevention can include applying a cool, wet compress to the affected area, keeping the nails trimmed, taking short, warm baths, and regularly moisturizing the skin.

Can lichenification be reversed?

Lichenification is often temporary and the lesion usually resolves after four weeks if treated properly.

What are the most important facts to know about lichenification?

Lichenification is a secondary skin lesion that is characterized by hyperpigmentation, thickening of the skin, and exaggerated skin lines. It usually appears in areas of constant scratching or rubbing. Lichenification can be further classified as primary, when it results from neurodermatitis, and secondary, when another medical condition is the underlying cause. Diagnosis focuses on reviewing medical history and examining the lesions to determine its cause. If the cause is unclear, a skin biopsy or psychological evaluation may be required. Treatment usually consists of using potent topical steroids and resolving the underlying cause. Other treatments may include antihistamines, light therapy, anti-anxiety medication, and psychotherapy, depending on the underlying cause. The lesions are often temporary and they may completely heal if treated properly. 

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Related links

Atopic dermatitis
Clinical Reasoning: Eczematous rashes

Resources for research and reference

Aboobacker, S., Harris, B. W., & Limaiem, F. Lichenification. In StatPearls. Retrieved January 15, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK537332/

Lotti T, Buggiani G, Prignano F. Prurigo nodularis and lichen simplex chronicus. Dermatol Ther. 2008 Jan-Feb. 21(1):42-6.

Glazenburg, E. J., Mulder, P. G., & Oranje, A. P. (2015). A Statistical Model to Predict the Reduction of Lichenification in Atopic Dermatitis. Advances in Dermatology and Venereology, 95(3): 294-7. DOI: 10.2340/00015555-1881. 

Sbrana, F., Loggini, B., Galimberti, S., et al. (2016). Chronic skin lichenification as unusual presentation of eosinophilic granulomatosis with polyangitis: case report and literature review. Acta Reumatologica Portuguesa, 41(2): 158-61.

Weber, F. P. & Jupe, F. (1935). Lichenification. Proceedings of the Royal Society of Medicine, 28(5):510-1.