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Lichen Simplex vs Normal Eczema - What is the Difference?

Lichen simplex is a localized, well-circumscribed area of thickened skin (lichenification) resulting from repeated rubbing, itching, and scratching of the skin.

A solitary plaque of lichen simplex is circumscribed, somewhat linear or oval in shape, and markedly thickened. It is intensely itchy. Some places often get these lesions, for example:

  • back of scalp and neck
  • genitals
  • wrists/forearms
  • shin bone area

Both Chinese herbal medicine and acupuncture can bring relief to a person suffering from lichen simplex.

What is Lichen Simplex?

Lichen Simplex is a chronic dermatitis caused by repeated skin scratching and rubbing. Rubbing may cause further itching, and thus continued scratching, creating a vicious itch-scratch cycle. Lichen Simplex, which used to be known as Neurodermatitis, is characterized by an inflamed thickened patch of skin (often darker than surrounding skin) that has a leathery scaly texture

It affects people from 30 to 55 years of age. Women are more prone. Lichen simplex can happen in any person without pre-existing skin issues. It can also occur in:

  1. people who suffer from mental health disorders like OCD (repeated scratching)
  2. people who are already afflicted with atopic dermatitis

What are Common Causes of Lichen Simplex?

The cause for Lichen simplex is the itch-scratch cycle as mentioned above. The inciting stimulus for the itch could be due to:

  1. Itching skin conditions like psoriasis, eczema or contact dermatitis.
  2. Psychological factors like stress.
  3. Mental health disorders like OCD where repeated scratching may be a symptom.
  4. Neurological conditions.
  5. Environmental factors like allergens or irritants.

What are different ways of treating Lichen Simplex?

Because Lichen Simplex is primarily a result of persistent scratching or rubbing of the skin in response to itch or irritation, treatment is often symptomatic and localized.

  • Steroids may be used, but typically require high-potency formulations due to the thickness of the skin.
  • Emollients can help, but the focus is on addressing the underlying cause and managing the itch-scratch cycle.
  • Anti-itch medications may also be prescribed, but effectiveness may be limited due to the chronic nature of the condition.
  • Behavioral therapy, such as habit reversal training, may be recommended to break the itch-scratch cycle. For those with neurodermatitis induced by mental health disorders, antipsychotics may be prescribed.
  • Lichen Simplex Chronicus, which often results in thickened and leathery skin, may require extended management but with a focus on behavior modification.

Lichen Simplex vs Normal Eczema

The question here is how we can differentiate Lichen Simple from “Normal” Eczema aka Atopic Dermatitis.

Definition: Atopic Dermatitis is a chronic inflammatory skin condition associated with allergies and a disrupted skin barrier.
Lichen Simplex is a skin disorder characterized by localized itching and chronic scratching, often due to psychological or physical triggers.

Causes: Atopic Dermatitis is due to genetic predisposition, immune system dysfunction, environmental factors and allergies.
Lichen Simplex is often due to psychological stress, repetitive friction or rubbing, although it can also be due to an underlying skin condition.

Location: Atopic Dermatitis can appear in various parts of the body but is most common in flexural areas (elbows, knees) in children and face and neck in adults. Lichen Simplex typically occurs in localized areas, often on the back, neck, forearms or the shin and ankle area.

Appearance: Atopic Dermatitis often presents as red, dry, itchy and inflamed skin with scaling and sometimes oozing, particularly during flares. On the other hand, Lichen Simplex is identified as raised, thickened, scaly patches of skin with an intense itch, often forming a distinct plaque.

Triggers: Atopic Dermatitis is triggered by Allergens (e.g., pollen, dust mites, foods), irritants and environmental factors. On the other hand, Lichen Simplex is more often than not triggered by stress, repetitive scratching and friction. It is sometimes triggered by an underlying skin flare.

Age of Onset: Atopic Dermatitis often starts in infancy or early childhood, but can affect individuals of any age. Lichen Simplex usually begins in adulthood, commonly between the ages of 30 and 50.

Management: Atopic Dermatitis is managed by emollients, topical steroids, antihistamines, immunomodulators and lifestyle adjustments. Lichen Simplex is managed using topical steroids, antihistamines, stress management techniques, and addressing underlying skin issues if present.

Prognosis: Atopic Dermatitis often improves or resolves in childhood, but may recur in adulthood. Lichen Simplex can be managed with proper treatment and stress management, but symptoms typically persist for a long time.


To summarize, Lichen Simplex is a chronic skin condition that includes a behavioral component. However, it is true that there can be an overlap of Lichen Simplex and “Normal” Eczema, where the underlying eczematic condition predisposes the sufferer to consistently scratch on the same location, creating a vicious loop of itch-scratch-itch and chronically damaged skin.

People experiencing such a situation do well to consider using Chinese Medicine to treat both the Lichen Simplex and the Atopic Dermatitis.

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