Symptoms, Causes, Treatment, and More

Repeatedly scratching an area can cause lichenification, which is thickened, rough, and dark skin. The name comes from its resemblance to lichen, a plant-like growth found on rocks and trees.

Lichenification is not a condition on its own; it’s how your skin reacts to long-term irritation or scratching, often from eczema or psoriasis.

There are two types of lichenification: primary and secondary.

Primary lichenification, or lichen simplex chronicus, occurs when there is no skin condition causing your itch. Stress, anxiety, obsessive-compulsive disorder (OCD), bug bites, tight clothing, dry skin, or nerve irritation can trigger it.

Secondary lichenification develops when a skin condition makes you itch, causing you to scratch more.

When you have lichenification, you may notice symptoms on the skin in areas such as your head, neck, scrotum or vulva, arms, scalp, or thighs. Symptoms include:

• Deep lines or crisscross patterns
• Dry, leathery, or bumpy patches
• Areas that appear gray, reddish-brown, yellow, or darker than usual
• Thicker, rougher patches that feel different from the surrounding area

How It Looks on Different Skin Tones

Lichenification doesn’t always look the same on everyone. Your skin tone can affect how it appears.

In people of Asian descent, lichenification may appear as thick, scaly plaques with sharp edges and clear borders. On darker skin, it may appear as shades of purple, gray, or dark brown, especially around the elbows, knees, or knuckles where the skin bends and stretches.

Anything that causes you to scratch or rub your skin often can cause lichenification. The more you scratch, the thicker and itchier your skin may become. This can create an itch-scratch cycle that’s hard to break, causing lasting changes in your skin’s texture and color. 

Risk Factors

You’re more likely to develop secondary lichenification if you have a skin condition such as:

• Eczema
• Pityriasis rubra pilaris (red, scaly patches)
• Porokeratosis (thick, rough patches)
• Psoriasis (red, scaly patches)
• Skin infections
• Dry skin

You’re more likely to develop primary lichenification if you:

• Are female
• Are 30-50 years old
• Have anxiety, stress, or obsessive-compulsive disorder (OCD)

Lichenification is more prevalent among people with darker skin because eczema symptoms may be less apparent at first, which can delay diagnosis and early treatment. This increases the likelihood of severe itching and widespread eczema, making it harder to prevent lichenification.

To make a diagnosis, a healthcare provider will likely examine your skin and ask about your symptoms, triggers, and family history. They may also order tests such as:

• Blood tests: Testing a blood sample can help your provider determine the cause of your itchy skin. A blood test may include an immunoglobulin E (IgE) test to detect allergies.
• Patch testing: This type of allergy testing can help determine if you have allergies contributing to your itching. It involves applying different allergens to your skin to see if you have an allergic reaction.
• Potassium hydroxide examination: For this test, your provider collects a small skin sample, applies a chemical solution, and examines it under a microscope to detect or rule out a fungal infection.
• Skin biopsy: For a skin biopsy, your healthcare provider will examine a small skin sample for inflammation or disease.
• Skin culture: This swab or biopsy test helps detect bacteria, fungi, and other germs.

Lichenification treatment focuses on breaking the itch-scratch cycle so your skin can heal. Treatment may involve skincare, topical treatments, and other medications. If you have darker skin, you may need early and aggressive treatment to manage severe symptoms.

Skincare and Prevention Tips

Skincare tips to prevent scratching that may lead to lichenification include: 

• Apply thick creams or ointments within three minutes of bathing
• Limit showers to 10 minutes or less with warm (not hot) water
• Practice deep breathing, journaling, or mindfulness to reduce stress
• Use gentle, fragrance-free soaps and skincare products
• Wear soft, breathable fabrics
• Use cool cloths, aloe vera, or colloidal oatmeal baths and lotions to soothe itching

Wet wrap therapy may help with severe skin irritation. For this, you apply moisturizer or medication, cover it with a damp gauze wrap, and leave it on for two hours or overnight. You may do this for several days.

Topical Treatments

If at-home care doesn’t work, your provider may recommend you apply topical treatments directly to the skin to help reduce symptoms. Topical medications include:

• Aspirin (acetylsalicylic acid) with dichloromethane (methylene chloride): This compounded mixture may relieve pain and swelling by reducing inflammation. 
• Calcineurin inhibitors: Nonsteroidal medications like Elidel (pimecrolimus) and Protopic (tacrolimus) reduce inflammation and itching by blocking specific immune system responses.
• Capsagel (capsaicin): This medication, made from chili peppers, helps reduce itching by desensitizing nerve endings over time.
• Corticosteroids: Anti-inflammatory steroid medications like Clobex (clobetasol), Cortizone-10 (hydrocortisone), and Diprolene (betamethasone) may help reduce redness, swelling, and itching.
• Phosphodiesterase-4 (PDE4) inhibitors: Eucrisa (crisaborole) helps lower swelling and itching by blocking enzymes that cause inflammation.
• Zonalon (doxepin): This topical anti-itch medication helps relieve itching by blocking histamine receptors in the skin.

Oral and Injectable Treatments

Oral and injectable medications work throughout your body to help calm your immune system, reduce inflammation, or relieve itching. Options include:

• Anti-anxiety medications: Xanax (alprazolam) and Ativan (lorazepam) may help reduce stress-related scratching.
• Antibiotics: These help treat skin infections that may cause itching.
• Antihistamines: Benadryl (diphenhydramine), Claritin (loratadine), and Zyrtec (cetirizine) help stop itching from allergies.
• Biologics: Dupixent (dupilumab) helps calm your immune system to reduce swelling, redness, and infection risk.
• Immunosuppressants: CellCept (mycophenolate mofetil), Imuran (azathioprine), Neoral (cyclosporine), and Rheumatrex (methotrexate) help reduce inflammation by calming your immune system.
• Janus kinase (JAK) inhibitors: Cibinqo (abrocitinib), Rinvoq (upadacitinib), and Xeljanz (tofacitinib) block immune pathways to help reduce swelling and itching.

Additional Treatments

If medications don’t work, your provider may suggest:

Lichenification often occurs with other chronic skin conditions, including:

Living with lichenification can be frustrating, especially if the skin changes affect your confidence. Following a proper skincare routine and any medication plan recommended by your healthcare provider can help calm itching and promote healing.

Thick areas may take time to soften, and discoloration can take a while to fade, especially if you have darker skin. That’s normal and part of the healing process.

If your symptoms aren’t improving or you’re unsure what’s causing them, it’s important to talk to a healthcare provider. They can help you create or adjust your care plan.