Have you heard of lichen simplex chronicus before? You may have encountered the term while searching your symptoms on Google and trying to get a diagnosis. Perhaps you heard the term while watching a webinar on vulvovaginal health. Maybe you have a lichen simplex chronicus diagnosis, or your doctor thinks you *may* have this condition.
Regardless, it is essential to have a basic understanding of what lichen simplex chronicus is in order to better advocate for yourself. Further – and this is a spoiler alert – you can have both lichen sclerosus and lichen simplex chronicus. In this post, I share what lichen simplex chronicus is, the main signs and symptoms, and how it is treated. I also address a common question in support groups, “can I have both lichen sclerosus and lichen simplex chronicus”?
*This post is evidence-based; I draw on the medical literature to share what you need to know about lichen simplex chronicus. Importantly, what I share is my interpretation of the science and data.
What is Lichen Sclerosus?
Before we dive into lichen simplex chronicus (LSC), let us briefly review what lichen sclerosus (LS) is. Lichen sclerosus is a chronic, inflammatory skin condition considered an autoimmune condition by the majority of the medical community. It causes symptoms like pain and itching. It primarily affects the genitals but can occur in other parts of the body. Signs of lichen sclerosus involve hypopigmentation (lightening of the skin), scarring and architectural changes, as well as thickening of the skin/ skin that resembles cigarette paper. The gold standard treatment for LS is ultrapotent topical corticosteroids.
If you are new here and want to learn more about LS, check out this video I made on the topic.
If reading is your preferred medium, grab my FREE LS eBook (over 60+ pages of LS information).
What is Lichen Simplex Chronicus?
Lichen simplex chronicus (LSC) is a skin disorder caused by chronic itching. In the medical literature, LSC is also known as neurodermatitis, pruritus vulvae, squamous hyperplasia, and hyperplastic dystrophy. (Goldstein et al., 2006)
The main defining traits of LSC are itching, scratching, and skin thickening (ibid, BC Center for Vulvar Health). While LSC can occur anywhere on the body, when I discuss LSC in this post, I am referring to vulvar lichen simplex chronicus.
Unlike lichen sclerosus, LSC is not considered an autoimmune condition. Instead, the chronic itch characteristic of LSC results from repetitive scratching and rubbing (Goldstein et al., 2006).
What Causes LSC?
The cause of the itch behind LSC involves irritants or infections. For example, someone may use a vulvar product and have an allergic reaction. Alternatively, someone may experience a yeast infection. Both cases lead the person in question to scratch to relieve the itch. Many of us have done this; I know I used to scratch and rub when I had yeast infections.
For some folks, this scratching and rubbing result in mast cells in the area. Mast cells secrete a protein called histamine, which makes you itch even more (Goldstein, Pukall, and Goldstein, 2011). Of course, more itching leads to more scratching. This sets off something called the ‘itch-scratch' cycle. (CVVD, BC Centre for Vulvar Health, Goldstein et al., 2006, Goldstein, Pukall, and Goldstein, 2011).
The repetitive scratching and rubbing cause the vulvar skin to thicken. Areas of the vulva make it look coarse and leathery. In terms of color, areas of the vulva may show signs of hyperpigmentation. For example, the skin may appear pink, red, purple, or darker than your usual color (BC Centre for Vulvar Health).
Signs and Symptoms of Lichen Simplex Chronicus
Signs of lichen simplex chronicus include areas of thickened skin that may be darker in color than other areas of the vulva.
The main symptom of lichen simplex chronicus is chronic itch and a strong urge to scratch. The itch can be severe and wake you up at night. While itch and the urge to scratch is the hallmark symptom of LSC, you may also experience some pain. The pain is usually from damage to the skin that is caused by scratching. Sometimes fissures can occur from scratching, which can get infected with bacteria and require treatment. Fissures also cause pain (CVVD, BC Centre for Vulvar Health).
How is LCS Diagnosed?
Lichen simplex chronicus is typically diagnosed via clinical examination. Clinical examination involves your doctor taking a detailed history of your symptoms and examining the vulvar skin. In some cases, your doctor may recommend taking a biopsy to confirm or to help them make a differential diagnosis. A differential diagnosis involves tests to help the doctor determine which of several conditions are responsible for their patient's symptoms. (BC Centre for Vulvar Health, Goldstein et al., 2006).
Treatment for Lichen Simplex Chronicus
First, the goal of treatment for lichen simplex chronicus is to break the ‘itch-scratch' cycle.
Treatment often involves a combination of lifestyle changes and medication; let us look at both.
If you have lichen simplex chronicus, your doctor may recommend the following:
- Gently cleansing the skin. For example, do not overwash the vulva. When washing, use either warm water or a gentle, fragrance-free cleanser.
- Avoid irritants such as certain soaps, laundry detergents, fabric softeners, menstrual pads/pantyliners, vulvar products with fragrance, etc.
- Using an ice pack to help calm the itch. I recommend the brand Private Packs. Click here to get yours today, and use code THELOSTLABIACHRONICLES to get 15% off your first purchase.
- Avoid scratching and rubbing. And yes, this is incredibly hard but crucial to healing the skin. Ideally, you want to stop scratching for 6-8 weeks for the skin to heal (BC Centre for Vulvar Health).
Sometimes your doctor may recommend conservative treatment and have you start with lifestyle changes. Other doctors may also prescribe medications alongside lifestyle changes to help break the ‘itch-scratch' cycle.
Topical corticosteroids are often prescribed to help calm the inflammation and settle the itch. Typically, your doctor will either prescribe an ultrapotent steroid (e.g., Clobetasol 0.05%) or a strong to mid-potent steroid (e.g., Mometasone Fourtate 0.1%).
Once the ‘itch-scratch' cycle is broken, patients can discontinue using their medication. This is in contrast to lichen sclerosus, which requires the life-long use of steroid medication (Goldstein, Pukall, and Goldstein, 2011, BC Centre for Vulvar Health).
While less common, calcineurin inhibitors such as Pimecrolimus 1% cream are sometimes prescribed. An experimental study with 12 patients with lichen simplex chronicus showed Pimecrolimus 1% cream to be an effective treatment for LSC. Further, the authors noted no adverse side effects from this medication (Goldstein et al., 2006). *It is important to note that this study was experimental and not a randomized controlled study; hopefully, there will be more RCTs on this topic in the future.
Similar to steroids, calcineurin inhibitors are used for some time and discontinued once the ‘itch-scratch' cycle is broken.
Trycyclic antidepressants such as Elavil (amitriptyline) are often prescribed to treat various conditions such as neuropathic itch, neuropathic pain/neuralgia, chronic pain, etc. Low-dose Elavil (amitriptyline) *may* be prescribed if your itch is severe or the steroid medication does not provide enough relief initially. These medications can also help you sleep (I can attest to this as someone who was on low-dose amitriptyline for years due to trigeminal neuralgia/orofacial nerve pain).
Similar to steroids, tricyclic antidepressants are not prescribed for life. Instead, patients are to wean off them once they break the ‘itch-scratch' cycle and the skin has healed.
Do you Have LS, LSC, or both?
It is possible to have just lichen sclerosus, just lichen simplex chronicus, or both. Yes, you can have both! Remember, just because you have an LS diagnosis does not mean it is the only vulvovaginal condition you can have.
I know folks with both an LS and LSC diagnosis.
If you suspect LSC, speak to your doctor about it. If you have already been diagnosed with lichen sclerosus, you are likely already using steroids or calcineurin inhibitors. However, suppose they give you a secondary diagnosis of lichen simplex chronicus. In that case, you may need to follow some of the lifestyle changes above. They may even recommend therapy or clinical hypnosis to help control your urge to itch.
Knowledge is power, my friend. Having a proper diagnosis and understanding of your condition is fundamental for healing.
In sum, lichen simplex chronicus shares many similarities with lichen sclerosus. For example, both cause itch, and both cause lichenification (thickening of the skin). However, while LS is considered an autoimmune disorder, LSC is not. Both can be diagnosed either by clinical examination or a biopsy. Both are treated with topical corticosteroids or calcineurin inhibitors. However, a key difference is that while LS must be treated for life, most patients with LSC can stop their medication once their skin has healed (usually 6-8 weeks). Importantly, you can have both lichen simplex chronicus and lichen sclerosus, so if you think you have both, it is essential to communicate this with your doctor.
Curious about other causes for itch? Dr. Ulrike Dehaeck reviews common causes of vulvar itch in her talk from LSSN's 2022 Holistic Healing Summit. You can watch the replay by joining LSSN's membership.
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Sources Cited & Consulted
BC Center for Vulvar Health. “Lichen Simplex Chronicus.” Patient Handout. Access here.
Goldstein, a., Parneix-Spake, A., McCormick, C. L., and Burrows, L. J. “Pimecrolimus Cream 1% for Treatment of Vulvar Lichen Simplex Chronicus: An Open-Label, Preliminary Trial. Kagar AG, Basel, 2007.
Goldstein, A., Pukall, C., and Goldstein, I. “When Sex Hurts: A Woman's Guide to Banishing Sexual Pain.” Da Capo Press, First Edition. 2011.
Lynch PJ. Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital region. Dermatol Ther. 2004;17(1):8-19. doi: 10.1111/j.1396-0296.2004.04002.x. PMID: 14756886.