Lichen Simplex Chronicus of Scalp: Causes, Symptoms, & Treatment

Lichen Simplex Chronicus of scalp develops due to repeated scratching of scalp skin. It itself is not considered as primary skin disease but occurs after the scalp skin is exposed to physical injury or trauma such as constant rubbing or scratching due to itching. The scalp lesions mostly develop in the middle of the top of the scalp. The scalp lesions can then proceed to the nape or nuchal area at the back of the hairline. The conditions can be managed with some skin care regimens and change in habits. This article explains the causes, symptoms, treatment, and prevention of scalp Lichen Simplex Chronicus of scalp.

What is Lichen Simplex?

Lichen Simplex Chronicus of scalp also known as neurodermatitis circumscripta is a chronic inflammatory skin disease characterized by dry, rough, thickened skin lesions on the scalp. It occurs as a result of constant irritation due to strong and uncontrollable itching either as a habit or response to stress. The thick and darkened skin lesions in Lichen Simplex chronicus are mostly found on body areas that are easily accessible for scratching such as scalp, nape of neck, forearms and elbows, vulva and scrotum, upper medial thighs, knees, lower legs, and ankles. 

What Causes Lichen Simplex Chronicus of Scalp?

Lichen Simplex Chronicus of scalp is believed to be caused predominantly from excessive scratching due to habit or other skin conditions such as pruritus, eczema, dermatitis, etc. Other trigger that provoke scratching and subsequent Lichen Simplex lesions of scalp include,

  • Skin irritation on the scalp
  • Environmental factors, such as heat and sweating
  • Psychological factors, such as stress and anxiety
  • Obsessive-compulsive disorder
  • Skin condition such as scalp psoriasis, eczema, dermatitis, etc.

Who Gets Lichen Simplex Chronicus of Scalp?

Lichen Simplex Chronicus of scalp is observed to occur mostly in mid-to-late adulthood. The prevalence of lesions is highest in the age group of 30 and 50 years of age.  Experts also reveal that women are more prone to developing Lichen Simplex Chronicus of scalp than men.  However the occurrence of scalp lesions is not very common because people find it embarrassing to scratch the scalp as the habit gets noticed easily. Since pruritus is the predominant symptom that leads to the development of Lichen Simplex Chronicus of scalp, people with habit of scratching uncontrollably, mental conditions like anxiety, depression, or even obsessive compulsive disorder can get Lichen Simplex Chronicus of scalp.

  Following factors put you at risk of developing Lichen Simplex Chronicus 

  • Age group of 30 to 50 years
  • Female gender
  • Habit of scratching
  • Mental anxiety, stress or depression
  • Obsessive compulsive disorder

What are the Clinical Features of Lichen Simplex of Scalp?

Lichen Simplex Chronicus of scalp presents as skin lesions on the scalp especially on the vertex area. The scalp lesions become dark due to hyperpigmentation, and have a thick, dry and scaly skin. More prominent clinical features of Lichen Simplex Chronicus of scalp include,

  • Single or multiple irregular or polygonal-shaped plaques with slightly elevated red papules
  • Brown lesions covered by fine dry scales
  • Severe itching that worsens during the night
  • Dusky violaceous or brown hyperpigmentation

How is Lichen Simplex Chronicus of Scalp Diagnosed?

Lichen Simplex Chronicus of scalp can be diagnosed on the basis of skin examination as the symptoms are very typical. In some cases the doctor may scrape off the skin to take the sample for laboratory testing. Laboratory tasting confirms Lichen Simplex Chronicus and rules out the possibility of other skin conditions such as psoriasis, chronic eczema, or Lichen planus.

What is the Treatment for Lichen Simplex Chronicus of Scalp?

The treatment for Lichen Simplex Chronicusof scalp includes both topical as well as systemic medications as the treatment is intended for the itching as well as the underlying cause.

Topical Medications

  • Topical medications such as steroids, salicylic acid, capsacin, tacrolimus pimecrolimus, doxepin, and botulinum toxin is recommended to cure itching. The topical steroidal creams help to resolve lichen plaques.
  • Moisturising creams are used to prevent dryness of skin on the scalp
  • Cooling creams containing menthol help to give cooling effect

Systemic Medications

Systemic medications may include some agents that help to reduce stress, anxiety, and promote better sleep.

  • Antihistaminic medications help to reduce inflammation and itching
  • Antidepressant medications are given when the itching habit arise due to stressful event in life or mental condition such as depression
  • Antifungals or antibiotics may be recommended to cure underlying infections

The treatment for Lichen Simplex Chronicus of scalp resolves the itching and lesions completely. However, the lesions may leave a scar or some mild damaging. Relapse can occur when itching is aggravated due to heat, humidity, skin irritants or allergens. Relapse is more common in patients with co-morbid depression or other mental disorders.

Self-Care Guidelines

  • The first prevention tip is to control itching. Some experts suggest putting ice cube at the scalp areas that itch to reduce the sensation
  • Keep the skin lesions on scalp covered at night as the itching worsens at night and some people also tend to scratch the lesions in their sleep
  • Keep the scalp skin hydrated all the time with regular oil massage or applying moisturiser on the lesions
  • If the lesions show cracks, use topical antibiotics to prevent infection. Ask for doctor recommendation before using antibiotic creams
  • Since stress is a contributing factor that may cause itching, try some stress management therapies such as meditation, yoga, or relaxation therapies
  • Hydrocortisone creams can be used to reduce itching. However, it is recommended only on doctor’s advice.
  • Do not try to scrape off the harden skin over lesion on your own. This may cause wounds or cracks