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

Lichenification is a secondary skin lesion that’s 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. 

Lichenification is diagnosed based on history and physical examination. Common signs are chronic and uncontrollable scratching of the skin or skin lesions that may interfere with daily routine or sleep. Healthcare providers may inquire about underlying pruritic lesions and skin conditions (e.g., eczema, insect bites), as well as the presence of fevers that may be associated with infected skin. 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. 

Treatment for lichenification varies depending on the cause and the severity of the lesion. The main goals of treatment are to control 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, [CBT]) may also be recommended.  

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