Lichenification – What is, Definition, Symptoms, Causes, Treatment
If you suffer from a dermatological process known as lichenification, you are not alone.
People across the country — especially those who have other skin conditions — also have to deal with this issue.
In fact, Medscape reports that in one study, researchers found that around 12% of patients with a pruritic (itchy) skin condition had lichenification as one of their symptoms.(1)
Read on to find out more about this issue – and what to do if you have it.
What is Lichenification?
MedicineNet defines lichenification as a process in which the skin becomes thick and leathery (due to an overgrowth of the epidermis, the upper layer of skin, in a process called hyperkeratosis) and its markings become more distinctive.(2)
In other words, both the texture and the appearance of the skin are altered.
There are various risk factors for this problem apart from a history of certain skin conditions. While it is not conclusive, some studies have found that people of African and Asian descent are more vulnerable.
Women are more likely to get it than men and those between 30 and 50 are also at greater risk.
The causes of the lichenification process are more complicated than they sometimes appear:
- According to Blackwell, lichenification is often caused by scratching, which in turn is caused by the intense itchiness of the skin: this cycle of itching, scratching and further lichenification constitutes a vicious cycle that makes the condition worse.(3)
- The body’s inflammatory response is also believed to be part of the lichenification process.
- The patient’s immune system often plays a role in this issue.
- There is a psychological factor to this issue and people who have obsessive-compulsive disorder, anxiety or depression are also at greater risk.
- Some researchers also believe that the problem may be partly neurological and that nerves become over-excited and more prone to send messages of itchiness to the brain. For this reason, the problem is also known as “neurodermatitis“.
It may come as a relief to know that this problem is not contagious nor is it life-threatening. It is also important for patients to understand that lichenification is seldom a condition in and of itself: it is often secondary to another skin issue.
People who have eczema (also called atopic dermatitis)or other conditions which led to pruritis (itchiness) are particularly at risk.
Dermnet also notes that other conditions which put patients at risk for lichenification include psoriasis, lichen planus, fungal skin infections or even insect bites.(4) Continued scratching or rubbing of it itchy skin can lead to chronic irritation and begin the lichenification process.
In short, a vicious cycle is created: the more the skin itches, the more the patient scratches. And the more the skin is scratched, the itchier it becomes.
The symptoms of lichenification can vary from one individual to the next, but according to Merck, some of the most common ones include:(5)
» Dry, itchy patches of skin with possible scaling
» Patches that are often red (erythematic) or darker than the surrounding skin (a process called hyperpigmentation)
» Plaques (areas of thickened, leathery skin) that can also form, most commonly on parts of the body that are easily scratched, including the trunk, scalp and neck, limbs or around the anus
» Dermnet also reports that the plaques usually have a definite shape and border and can be circular or linear in shape.
Treating This Condition
Merck Manuals notes that there are a number of treatments that can help improve this condition:(5)
- Behavioral education, which is considered to be one of the most important aspects of treatment. Patients need to be educated not to scratch or rub the affected areas of skin due to the irritation that it causes.
- Triamcinolone or other topical corticosteroid creams that can help treat this condition by reducing the inflammation which is believed to be an underlying cause of lichenification.
- Surgical tape which has been impregnated with corticosteroids and which the patient will apply to the affected area in the morning and remove in the evening
- Intralesional injections (injections are given directly to the affected area itself) may sometimes be given
- Emollients, which try to help moisturize the affected area
- Topical capsaicin cream, which is very effective but which some patients cannot tolerate, since it is made from the active ingredients in cayenne peppers and can cause a burning sensation
- DermNet also notes that preparations with coal tar or cooling, menthol-based cream can help soothe down irritated skin(4)
Treating the Primary Condition
Again, since lichenification often happens secondary to another condition, treating this primary condition — such as atopic dermatitis — is necessary to stop the problem.
Treatments common for pruritic skin conditions include:
» Antifungal creams for fungal infections of the skin
» Phototherapy, or the use of controlled exposure to light
» Medications that suppress the immune system, such as corticosteroids, methotrexate or cyclosporin
» Antidepressants (usually tricyclic antidepressants like amitriptyline) to help with sleep
» Anti-epileptic drugs like gabapentin or valproate to treat neurological components of various skin disorders
What to Do
The good news is that there are plenty of things the patients can do to help improve this often frustrating condition.
According to the Mayo Clinic, these actions can include:(6)
- Refraining from scratching or rubbing the affected area and protecting it with coverings if necessary
- Managing stress, which is often a trigger for exacerbation
- Avoiding tight or scratchy clothing
- Applying wet compresses or using over the counter medications as needed
When to See an MD
While lichenification is not fatal, it can lead to a decrease in quality of life.
MedlinePlus states that it is especially important to see the doctor if:(7)
» The intense itching does not go away and/or the over-the-counter treatments are not effective
» The itching interferes with sleep or other activities of daily living
» It is also important to visit a doctor if symptoms worsen or if they include pain, swelling, redness, warmth or discharge, as these are potential signs of infection
Apart from getting effective treatment for this condition, it is important to seek medical advice because of possible complications. These include infections and cosmetic problems like permanent scarring or discoloration, according to DermNet.(4)
How Doctors Make a Diagnosis
The good news is that a diagnosis of this condition is often a matter of simply examining the affected area, according to Merck.(5)
However, sometimes the doctor will perform a procedure called a potassium hydroxide wet mount and biopsy. This is so that they can rule out other conditions such as lichen planus or psoriasis. A physician may also take scrapings of the skin to rule out issues like tinea infections.
As neurological issues can play a role in many skin conditions, diagnosis may also involve CT scans, X-rays or MRI’s of the spine and/or nerve conduction studies, according to Dermnet.(4)
However, patients should be aware that these studies are not always helpful.
New Research on Lichenification
Some patients, unfortunately, do not respond to the conventional treatments discussed above.
That is why keeping track of the latest developments is so important. New research is underway to develop innovative ways to help patients deal with this condition.
In separate studies, Medscape reports that treatments such as doxepin cream, a combination of aspirin and dichloromethane, topical immune suppressants like tacrolimus cream and even localized Botox injections have proven effective.
While more research needs to be done, these can offer hope for patients with resistant forms of this condition.
To sum up, lichenification is a process (often secondary to another skin disorder) where the skin becomes thick, leathery and intensely itchy. It is not contagious or life-threatening.
However, there are several things a patient can do to help deal with this condition:
» Consult with a physician so that a definite diagnosis can be made; this is usually by clinical exam and can help the doctor formulate an effective plan of care.
» Change behaviors by refraining from scratching or rubbing the affected areas, since this can cause chronic irritation.
» Be sure to discuss the pros and cons of a treatment before beginning it.