Neurodermatitis or Lichen Simplex
Neurodermatitis or Lichen Simplex is a localised area of eczema caused by repeated chronic rubbing or scratching. The back of the hand, neck, outer part of the forearm and lower leg, buttocks and genitalia are the usual sites. It tends to be very persistent and to reoccur and is more common in mid- to late adulthood, peaking between 30 and 50 years.
The trigger to scratch may be an existing skin condition such as atopic eczema or psoriasis or a compressed nerve leading to the skin that makes it itch (neuropathic itch or pruritus). Scratching may also be a response at times of stress and worry. Whatever the reason, the individual gets into a vicious itch/scratch cycle and so the skin becomes very thickened (lichenified) and different to the surrounding skin. It most commonly affects parts of the body easily reached like the nape of the neck, back of the hands, legs and genital areas.
In brown skin, the rubbing of the itchy area gives rise to considerable darkening or hyperpigmentation of the skin as well as lichenification.
Topical treatments to manage the itch/scratch, and advice which addresses life issues can be useful in managing this eczema.
The approach of Dr Christopher Bridgett, a psychiatrist specialising in eczema can be invaluable in treating neurodermatitis. His Combined Approach, using techniques to alter the habit of scratching alongside the use of emollients, corticosteroids or paste bandages on limbs can be extremely helpful. His method is clearly explained in The Eczema Solution, written by a patient who successfully followed Dr Bridgett's method and learnt how to stop scratching in 3 weeks.