What it is

➝ Lichen simplex chronicus (LSC) is a chronic skin disorder caused by repeated scratching and rubbing, leading to thickened, leathery, hyperpigmented plaques.

➝ It is often secondary to other itchy conditions (eczema, insect bites, psoriasis) or triggered by stress and anxiety.

➝ The key to management is breaking the itch–scratch cycle, which perpetuates skin thickening and chronic discomfort.

➝ In Korea, treatment combines anti-itch therapy, topical medications, behavioral strategies, and supportive skincare.

Why it’s done

→ To reduce severe itching that disrupts sleep and daily life.

→ To allow skin healing, since scratching worsens lichenification.

→ To prevent secondary infection and further thickening of plaques.

→ To improve cosmetic appearance, since LSC often affects visible or sensitive areas.

→ In Korea, management focuses on both medical and psychological control of itching.

Alternatives / Symptom Control Approaches

→ Topical corticosteroids: Medium- to high-potency applied under occlusion (plastic wrap, hydrocolloid dressing) to soften thick plaques.

→ Topical calcineurin inhibitors: Tacrolimus or pimecrolimus, especially for face, folds, or long-term maintenance.

→ Antihistamines: Non-sedating during the day, sedating at night to reduce nocturnal scratching.

→ Moisturizers and emollients: To restore the skin barrier and reduce dryness-triggered itch.

→ Neuropathic itch control: Gabapentin, pregabalin, or antidepressants (amitriptyline, doxepin) for refractory cases.

→ Behavioral therapy: Stress reduction, habit reversal therapy, and psychological support.

→ Physical methods: Occlusive dressings, wet wraps, or bandages to physically block scratching.

Preparation

→ Careful evaluation to identify underlying cause (eczema, fungal infection, contact dermatitis, psychiatric trigger).

→ Baseline counseling that LSC requires patience and long-term adherence, since relapse is common if scratching continues.

→ In Korea, dermatologists often use digital dermoscopy and photography to document progress and motivate patients.

How it’s Done – Breaking the Itch Cycle

→ Step 1: Control itch immediately

• Strong topical corticosteroid applied with occlusion for 2–4 weeks.
• Antihistamines to reduce itch and help sleep.
• Cold compresses to soothe acute flares.

→ Step 2: Maintain barrier repair

• Liberal use of thick, fragrance-free emollients (petrolatum, ceramides).
• Avoid hot showers, harsh soaps, and irritants.
• Use gentle cleansers and lukewarm water only.

→ Step 3: Prevent scratching

• Occlusive dressings or hydrocolloid patches.
• Cotton gloves at night for children.
• Short nails to minimize skin trauma.

→ Step 4: Address triggers

• Treat fungal infections or eczema if underlying.
• Manage stress and anxiety (meditation, counseling).
• Avoid scratching behaviors reinforced by habit.

→ Step 5: Long-term control

• Switch from steroids to calcineurin inhibitors for maintenance.
• Consider phototherapy (NB-UVB) for resistant cases.
• Neuropathic itch medications in severe, refractory disease.

Recovery

→ Within 2–4 weeks, itching and redness improve significantly if scratching is stopped.

→ Skin thickening softens gradually over 1–3 months.

→ Pigmentation changes may persist longer but fade over time.

→ Long-term remission is possible with consistent trigger avoidance and skin care.

Complications

→ Chronic scarring and pigmentation if scratching persists.

→ Secondary bacterial infection from open lesions.

→ Steroid side effects if overused without supervision.

→ Psychological burden: Stress, anxiety, and sleep disturbance perpetuate the itch cycle.

Treatment Options in Korea

→ Korean dermatology clinics use structured protocols combining potent topical steroids under occlusion with moisturizers.

→ Clinics emphasize skincare education with K-beauty barrier creams (ceramides, panthenol, madecassoside).

→ For resistant plaques, laser therapy or intralesional corticosteroid injections are sometimes offered.

→ Behavioral counseling is integrated, since many patients unconsciously scratch due to stress.

→ Hospitals often offer combination approaches: dermatology for skin healing, psychiatry for stress, and physiotherapy for relaxation.

→ With Korea’s integrated care model, patients benefit from medical, behavioral, and cosmetic approaches that help break the itch–scratch cycle and restore normal skin texture.