Lichen Simplex Chronicus: Clinical Perspectives and Emerging Therapeutic Strategies

Lichen simplex chronicus (LSC), also known as neurodermatitis, is a common chronic pruritic dermatosis defined by lichenified plaques resulting from persistent scratching. Though often secondary to underlying dermatologic, systemic, or psychological triggers, LSC represents a distinct clinical entity with significant morbidity. The hallmark itch-scratch cycle contributes not only to visible skin changes but also to substantial sleep disruption, emotional distress, and functional impairment. Psychological stress, anxiety, and depression are frequent comorbidities and can further perpetuate disease chronicity. This review provides a comprehensive summary of the evolving understanding of LSC, from its neuroimmune-driven pathogenesis to the wide spectrum of therapeutic strategies currently available. In addition to topical corticosteroids, novel approaches including immunomodulators, neuromodulators, Janus kinase (JAK) inhibitors, and biologics are being increasingly explored. Procedural therapies such as cryotherapy, fractional laser resurfacing, and botulinum toxin injections, have also emerged as valuable tools, particularly in treatment-refractory cases. Recent insights into type 2 inflammation and dysregulated sensory pathways have informed the rationale for these targeted strategies. In anatomically sensitive areas such as the genital region, where topical agents may be poorly tolerated, systemic treatments may be required. Given this complexity, individualized, multimodal treatment plans are critical to optimizing management and improving quality of life (QoL) in patients with LSC. By synthesizing current data on pathophysiology, diagnosis, and both established and emerging therapies, this review aims to guide clinicians in optimizing care for patients with LSC and addressing its far-reaching psychosocial burden.