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.

How Do We Treat Lichen Simplex? (1 Case Study)

Lichen Simplex vs Normal Eczema

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

[1] 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.

[2] 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.

[3] 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.

[4] 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.

[5] Triggers:

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

[6] 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.

[7] 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.

[8] 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.

Summary

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.

Lichen Amyloidosis: The Look-Alike on the Shins

Lichen amyloidosis is the condition most often mistaken for lichen simplex, and we see a good deal of it. It shows up as firm, itchy, dome-shaped papules, most often on the shins, and the giveaway is the pattern — the papules line up in ripples or waves rather than forming one solid plaque. The colour is usually brown or grey-brown rather than red.

What is happening underneath is different. In lichen amyloidosis, amyloid material is deposited in the upper layer of the dermis. The prevailing explanation is that persistent scratching damages the keratinocytes, and the debris from those damaged cells converts into the amyloid deposits that make the papules firm.

So the itch-scratch cycle sits at the centre of this one too, which is why it responds to the same approach. It is also notably more common in people of Southeast Asian descent, which is part of why it turns up in our clinic more often than the textbooks would suggest.

What Lichen Simplex Is Called in Chinese

The modern medical term is 神经性皮炎 (shén jīng xìng pí yán) — literally nerve-related dermatitis, which is where the old English name neurodermatitis comes from.

The classical dermatology texts describe it by what it looks like. 牛皮癣 (niú pí xuǎn), ‘ox-hide lichen’, is the thick leathery patch itself. 摄领疮 (shè lǐng chuāng), ‘collar-grabbing sore’, is the version on the nape of the neck, named for exactly where a stiff collar rubs.

One word of warning if you are searching in Chinese. Modern colloquial usage has drifted, and 牛皮癣 is now commonly used to mean psoriasis, which is a completely different condition. If you search that term you will mostly get psoriasis results. For lichen simplex, search 神经性皮炎.

Lichen amyloidosis is 皮肤淀粉样变 (pí fū diàn fěn yàng biàn), cutaneous amyloidosis.