Thickened Skin (Lichenification) in Eczema

Atopic dermatitis (commonly known as eczema) can cause long-term inflammation and itchiness. Over time, and after lots of scratching, areas of the skin can become thickened and sometimes scar.^1-3

What is lichenification?

Lichenification is another word for thickening of the skin. It is sometimes called lichen simplex. Areas of thickened skin often appear darker than the skin around them. They may also feel rough or leathery. Thickened patches can lead to nodules under the skin that make the skin feel lumpy. Thickened skin can also become scaly or stop growing hair.^3,4

These thickened areas (called plaques) can be of various sizes and colors, especially on different skin tones. On lighter skin, they may appear pink or red. On darker skin, these plaques may appear brown or purple.⁵

Lichenification is caused by long-term itching. As you scratch an itchy spot, you cause damage to the skin. This makes the skin break down and leads to more irritation and inflammation. This cycle can continue over and over, making the skin thick and scarred over time. Plaques can arise anywhere you are able to scratch.^3,4

Why does thickened skin occur with eczema?

In some cases, the urge to itch comes on its own. This is called neurodermatitis. Other times, the urge to itch is due to an underlying issue like eczema. Itching is one of the most common symptoms of eczema.^3,4,6

In eczema, a weakened skin barrier and increased inflammation leads to skin breakdown and irritation. This process can then cause severe itching. And as you scratch the areas of skin affected by eczema, you cause more damage.¹

Without prevention or treatment, these patches thicken and harden. However, some people will still develop areas of thickened skin even with treatment. Some of these areas may be permanent, while others will improve with treatment over time.^3,4

Eczema can also increase the risk of developing mental health conditions like anxiety and depression. These conditions, along with stress, can further increase the urge to itch and make skin thickening worse.^1,4,6

How is thickened skin prevented and treated?

First-line prevention and treatment options for thickened skin include lifestyle changes and over-the-counter treatments. These may include:^2,4,7

• Placing wet cloths or band-aids on the skin to prevent direct contact
• Wearing loose-fitting, non-irritating clothing (avoiding wool or scented detergents)
• Reducing stress as much as possible
• Addressing any mental health concerns like depression or anxiety
• Keeping nails trimmed short
• Using emollients or anti-itch creams to keep the skin moisturized, especially after showering
• Taking over-the-counter antihistamine drugs like Benadryl

If these changes do not control itching or if plaques are not getting better, there are other options your doctor might recommend. These include using:^2,4,7

• Prescription steroid, immune system-suppressing, or anti-itch creams
• Injections of steroids directly into plaques
• Drugs to treat depression or anxiety
• Drug-containing skin patches to reduce the urge to itch
• Botox injections
• Light therapy (phototherapy)
• Acupuncture
• Surgery to remove specific types of plaques

Thickened skin can be caused by underlying issues besides eczema. These include certain infections, mental health conditions, some cancers, other skin conditions, and issues with red blood cells.^3,4

If there is concern for another underlying issue, your doctor may take a sample of skin from the area to look at under a microscope (skin biopsy). They may also run some basic lab tests. Treating any other underlying issue can also help prevent further lichenification.⁴