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Lichenification is a skin lesion that develops due to excessive rubbing or itching. It can also occur because of an underlying health disorder.

Lesions caused by lichenification are characterized as thickened and hardened skin. This article discusses the symptoms of lichenification, its causes, and treatment options.

Older woman scratching her arm

Maria Fuchs / Getty Images

What Are the Symptoms of Lichenification?

The first sign of lichenification is hyperpigmentation, which is when the skin becomes darker than the skin around it. As the condition worsens, other symptoms associated with lichenification can develop, such as:

  • Small, raised bumps on the patch of skin affected
  • Thickening of the skin
  • More pronounced skin lines

The thickening of the skin and skin lines associated with lichenification follow the development of hyperpigmentation and small bumps.

Types of Lichenification

The two types of lichenification are:

  • Primary: Primary lichenification develops idiopathically, meaning without an underlying cause. In some cases, primary lichenification can develop because of a condition known as neurodermatitis, in which the skin in one area becomes excessively itchy when no other health condition responsible.
  • Secondary: Secondary lichenification develops because of an underlying health disorder that causes excessive itching in the affected area.

What Causes Lichenification?

Primary lichenification develops from excessive itching, scratching, or rubbing. This extreme itch isn’t associated with any underlying physical cause and is referred to as neurodermatitis or lichen simplex chronicus.

Secondary lichenification can develop as a symptom or result of several different health disorders, including:

  • Dermatitis
  • Eczema
  • Xerosis (dry skin)
  • Psoriasis
  • Dermatophyte infections
  • Bug bites
  • Severe anxiety
  • Obsessive-compulsive disorder (OCD)

These health disorders are often characterized by their effects on the skin. They tend to cause itchiness and other skin symptoms, including lichenification, since many people with these disorders experience an uncontrollable itch that is hard to resist scratching.

In anxiety and OCD, the itchiness and development of lichenification are often associated with the itch-scratch-itch cycle. This cycle, which can be incredibly difficult to avoid, starts with a minor itch. Once a person scratches, the area becomes even more irritated, leading to the cycle continuing until the skin develops complications.

Where Does Lichenification Appear on the Skin?

Primary lichenification typically can be found on the scalp, neck, arms, and genitals. Secondary, on the other hand, can develop anywhere on the body, including the following:

  • Thighs
  • Abdomen
  • Face
  • Flanks
  • Lower legs
  • Chest 

What Medications Can Cause Lichenification?

There is little research available on what types of medications cause lichenification.

However, one case report has found that it may be a possible but rare side effect of the diabetes drug metformin.

How Is Lichenification Treated?

Lichenification has many treatment options, depending on the cause. Primary lichenification caused by lichen simplex chronicus and secondary lichenification are treated with:

  • Steroid creams, lotions, and injections to soothe itching and irritation
  • Medicine to numb the area to relieve feelings of itchiness
  • Ointments that contain specific ingredients to thin patches of thick skin, such as salicylic acid, lactic acid, or urea
  • Oral antihistamines to control itching
  • Antidepressants or antianxiety medications
  • Stress management techniques
  • Steroid injections
  • Behavior modification, psychotherapy, and counseling

Primary lichenification is treated with antidepressants, antianxiety medications, and behavior modifications. Anti-itch creams are used short term to relieve the symptom.

For secondary lichenification, therapy is dependent on the cause. The treatments mentioned above can also be used for secondary lichenification. For example, if the cause of lichenification is atopic dermatitis, topical steroid creams may be used, whether prescription or over the counter (OTC).

At-home treatments, such as using a cool compress on the area and a gentle moisturizer several times a day, can also help control the itching so that the lesion does not worsen.

Can Lichenification Be Cured?

Lichenification is often associated with incurable disorders. However, those same disorders are often highly manageable with the right therapy and approach. Because of this, lichenification can be effectively managed with proper treatment.

What Are the Complications and Risk Factors Associated With Lichenification

As is the case with many skin disorders driven by itch, infection is one of the main complications associated with lichenification.

When the area is continuously scratched, it can open the skin and allow bacteria and other germs to get in.

Permanent scarring and hyperpigmentation are also possible but don’t happen in all cases of lichenification.

Are There Tests to Diagnose the Cause of Lichenification?

A physical exam of the skin is often enough for a healthcare provider to determine if lichenification is present. However, the underlying cause needs to be investigated further to begin proper treatment, usually with a skin biopsy, which involves removing a skin sample and examining it under a microscope for signs of disease.

Skin biopsies are the most common tests healthcare providers use when diagnosing the cause of lichenification.

Lichenification and Psychological Testing

If no underlying physical cause is found, psychological examinations will be performed to determine if anxiety or another type of mood disorder is responsible for lichenification.

When to See a Healthcare Provider

You should see a healthcare provider if you experience any excessive sensations of itch on the skin that interfere with your daily life or cause you to scratch so much that a lesion begins to develop.

Lichenification is often associated with underlying health disorders that are highly manageable, such as eczema, so it’s essential to get the proper diagnosis for relief of the itchiness and irritation.


Lichenification can develop idiopathically because of excessive itch or secondary to underlying health disorders. It presents as a thickened layer of skin that's darker than the skin around it. Treating lichenification can be a simple process once the cause has been identified.

The mainstay diagnosis for the symptom is a skin biopsy, and the treatment options include various creams, ointments, or injectable medicines designed to relieve itching and irritation. If you experience any signs of lichenification, see a healthcare provider. They will determine the cause and develop an effective treatment plan to clear up the symptom.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Osmosis from Elsevier. Lichenification.

  2. Altunay İK, Özkur E, Uğurer E, Baltan E, Aydın Ç, Serin E. More than a skin disease: stress, depression, anxiety levels, and serum neurotrophins in lichen simplex chronicus. An Bras Dermatol. 2021 Nov-Dec;96(6):700-705. doi:10.1016/j.abd.2021.04.011

  3. Díaz JM, Bruñén JMG, Cameo RB, González AM. Erythroderma and Chronic Lichenification Due to Metformin. Eur J Case Rep Intern Med. 2019 May 29;6(6):001119. doi:10.12890/2019_001119

  4. Medline Plus. Lichen simplex chronicus.

  5. Pathania YS, Apalla Z, Salerni G, Patil A, Grabbe S, Goldust M. Non-invasive diagnostic techniques in pigmentary skin disorders and skin cancer. J Cosmet Dermatol. 2022 Feb;21(2):444-450. doi:10.1111/jocd.14547

By Angelica Bottaro
Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space.