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Lichen simplex chronicus
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<h2 id="signs-and-symptoms">Signs and symptoms</h2> <p>People burdened with LSC report <a href="/facts/Itch/MBWq6SPc">pruritus</a>, followed by uncontrollable scratching of the same body region, excessively.<a class="footnote-ref" id="fnref:5" href="#fn:5"><sup>5</sup></a> Most common sites of LSC are the sides of the neck, the scalp, ankles, vulva, pubis, scrotum, and extensor sides of the forearms.<a class="footnote-ref" id="fnref:6" href="#fn:6"><sup>6</sup></a> However, due to the <a href="/facts/Social_stigma/HXG8pDsF">stigma</a> associated with chronic scratching, some patients will not admit to chronic rubbing or abrasion. The skin may become thickened and hyperpigmented (lichenified) as a direct result of chronic excoriation.<a class="footnote-ref" id="fnref:7" href="#fn:7"><sup>7</sup></a> Typically this period of increased scratching is associated with stressors. </p> <h2 id="causes">Causes</h2> <p>This is a skin disorder characterized by a self-perpetuating scratch-itch cycle:<a class="footnote-ref" id="fnref:8" href="#fn:8"><sup>8</sup></a> </p> <ul><li>It may begin with something that rubs, irritates, or scratches the skin, such as clothing.</li> <li>This causes the person to rub or scratch the affected area. Constant scratching causes the skin to thicken.</li> <li>The thickened skin itches, causing more scratching, causing more thickening.</li> <li>Affected area may spread rapidly through the rest of the body.</li></ul> <p>Many hypothesize LSC has a psychosomatic origin.<a class="footnote-ref" id="fnref:9" href="#fn:9"><sup>9</sup></a> Those predisposed to itch as a response to emotional tensions may be more susceptible to the itch-scratch cycle. It may also be associated with nervousness, <a href="/facts/Anxiety/Geekl883">anxiety</a>, <a href="/facts/Clinical_depression/l2lQeWqr">depression</a>, and other psychological disorders.<a class="footnote-ref" id="fnref:10" href="#fn:10"><sup>10</sup></a><a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a> Many people with LSC are aware of the scratching they do during the day, but they might not be aware of the scratching they do in their sleep.<a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a> LSC is also associated with <a href="/facts/Atopy/7QqBDPII">atopy</a>, or <a href="/facts/Atopic_dermatitis/DvmdVwWu">atopic dermatitis</a> (eczema) and an increase of histamine levels.<a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a> </p> <h2 id="diagnosis">Diagnosis</h2> <p>LSC is typically diagnosed by careful observation and history taking.<a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a> It is easily recognized (see <i>signs and symptoms</i>, and <i>gallery</i>).<a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a> Biopsies are sometimes necessary to confirm the diagnosis and differentiate it from other similar appearing lesions. </p> <h2 id="treatment">Treatment</h2> <p>Treatment is aimed at reducing itching and minimizing existing lesions because rubbing and scratching exacerbate LSC. The itching and inflammation may be treated with a lotion or <a href="/facts/Steroid/4AhMbgXt">steroid</a> cream (such as <a href="/facts/Kenalog/8oe3CSR5">triamcinolone</a> or <a href="/facts/Betamethasone/qM3DSjSR">Betamethasone</a>) applied to the affected area of the skin.<a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a> Night-time scratching can be reduced with sedatives and antihistamines.<a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a> <a href="/facts/Doxepin/BbXzB5dg">Doxepin</a> is often prescribed, as it offers both antihistamine properties and is also effective at reducing the (itch scratch cycle) associated with the obsessive <a href="/facts/Psychosomatic/jpUW2loX">psychosomatic</a> behavioral symptoms. </p> <h3>Gallery</h3> <h2 id="see-also">See also</h2> <ul><li><a href="/facts/List_of_cutaneous_conditions/U58kszg2">List of cutaneous conditions</a></li></ul> <h2 id="external-links">External links</h2> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "4. Pruritus and neurocutaneous dermatoses". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Elsevier. pp. 53–54. ISBN 978-0-323-54753-6. <a href="978-0-323-54753-6" target="_blank">978-0-323-54753-6</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "4. Pruritus and neurocutaneous dermatoses". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Elsevier. pp. 53–54. ISBN 978-0-323-54753-6. <a href="978-0-323-54753-6" target="_blank">978-0-323-54753-6</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "4. Pruritus and neurocutaneous dermatoses". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Elsevier. pp. 53–54. ISBN 978-0-323-54753-6. <a href="978-0-323-54753-6" target="_blank">978-0-323-54753-6</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "4. Pruritus and neurocutaneous dermatoses". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Elsevier. pp. 53–54. ISBN 978-0-323-54753-6. <a href="978-0-323-54753-6" target="_blank">978-0-323-54753-6</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>Lynch, Peter J. (2004-01-01). "Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital region". Dermatologic Therapy. 17 (1): 8–19. doi:10.1111/j.1396-0296.2004.04002.x. ISSN 1396-0296. PMID 14756886. S2CID 22038447. <a href="https://doi.org/10.1111%2Fj.1396-0296.2004.04002.x" target="_blank">https://doi.org/10.1111%2Fj.1396-0296.2004.04002.x</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>Lotti, Torello; Buggiani, Gionata; Prignano, Francesca (2008-01-01). "Prurigo nodularis and lichen simplex chronicus". Dermatologic Therapy. 21 (1): 42–46. doi:10.1111/j.1529-8019.2008.00168.x. ISSN 1529-8019. PMID 18318884. S2CID 41222102. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></p></li> <li id="fn:7"><p>Lotti, Torello; Buggiani, Gionata; Prignano, Francesca (2008-01-01). "Prurigo nodularis and lichen simplex chronicus". Dermatologic Therapy. 21 (1): 42–46. doi:10.1111/j.1529-8019.2008.00168.x. ISSN 1529-8019. PMID 18318884. S2CID 41222102. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></p></li> <li id="fn:8"><p>Lee, Michael R.; Shumack, Stephen (2005-11-01). "Prurigo nodularis: a review". The Australasian Journal of Dermatology. 46 (4): 211–218, quiz 219–220. doi:10.1111/j.1440-0960.2005.00187.x. ISSN 0004-8380. PMID 16197418. S2CID 30087432. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></p></li> <li id="fn:9"><p>Lotti, Torello; Buggiani, Gionata; Prignano, Francesca (2008-01-01). "Prurigo nodularis and lichen simplex chronicus". Dermatologic Therapy. 21 (1): 42–46. doi:10.1111/j.1529-8019.2008.00168.x. ISSN 1529-8019. PMID 18318884. S2CID 41222102. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></p></li> <li id="fn:10"><p>Konuk, Numan; Koca, Rafet; Atik, Levent; Muhtar, Sennur; Atasoy, Nuray; Bostanci, Bora (2007-05-01). "Psychopathology, depression and dissociative experiences in patients with lichen simplex chronicus". General Hospital Psychiatry. 29 (3): 232–235. doi:10.1016/j.genhosppsych.2007.01.006. ISSN 0163-8343. PMID 17484940. <a href="http://www.ghpjournal.com/article/S0163-8343(07)00007-2/abstract" target="_blank">http://www.ghpjournal.com/article/S0163-8343(07)00007-2/abstract</a> <a href="#fnref:10" class="footnote-back-ref">↩</a></p></li> <li id="fn:11"><p>Krishnan, Anjeli; Koo, John (2005-07-01). "Psyche, opioids, and itch: therapeutic consequences". Dermatologic Therapy. 18 (4): 314–322. doi:10.1111/j.1529-8019.2005.00038.x. ISSN 1396-0296. PMID 16297003. S2CID 25983822. <a href="https://doi.org/10.1111%2Fj.1529-8019.2005.00038.x" target="_blank">https://doi.org/10.1111%2Fj.1529-8019.2005.00038.x</a> <a href="#fnref:11" class="footnote-back-ref">↩</a></p></li> <li id="fn:12"><p>Lynch, Peter J. (2004-01-01). "Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital region". Dermatologic Therapy. 17 (1): 8–19. doi:10.1111/j.1396-0296.2004.04002.x. ISSN 1396-0296. PMID 14756886. S2CID 22038447. <a href="https://doi.org/10.1111%2Fj.1396-0296.2004.04002.x" target="_blank">https://doi.org/10.1111%2Fj.1396-0296.2004.04002.x</a> <a href="#fnref:12" class="footnote-back-ref">↩</a></p></li> <li id="fn:13"><p>Lynch, Peter J. (2004-01-01). "Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital region". Dermatologic Therapy. 17 (1): 8–19. doi:10.1111/j.1396-0296.2004.04002.x. ISSN 1396-0296. PMID 14756886. S2CID 22038447. <a href="https://doi.org/10.1111%2Fj.1396-0296.2004.04002.x" target="_blank">https://doi.org/10.1111%2Fj.1396-0296.2004.04002.x</a> <a href="#fnref:13" class="footnote-back-ref">↩</a></p></li> <li id="fn:14"><p>Lotti, Torello; Buggiani, Gionata; Prignano, Francesca (2008-01-01). "Prurigo nodularis and lichen simplex chronicus". Dermatologic Therapy. 21 (1): 42–46. doi:10.1111/j.1529-8019.2008.00168.x. ISSN 1529-8019. PMID 18318884. S2CID 41222102. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:14" class="footnote-back-ref">↩</a></p></li> <li id="fn:15"><p>Lynch, Peter J. (2004-01-01). "Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital region". Dermatologic Therapy. 17 (1): 8–19. doi:10.1111/j.1396-0296.2004.04002.x. ISSN 1396-0296. PMID 14756886. S2CID 22038447. <a href="https://doi.org/10.1111%2Fj.1396-0296.2004.04002.x" target="_blank">https://doi.org/10.1111%2Fj.1396-0296.2004.04002.x</a> <a href="#fnref:15" class="footnote-back-ref">↩</a></p></li> <li id="fn:16"><p>Yosipovitch, Gil; Bernhard, Jeffrey D. (2013-04-25). "Chronic Pruritus". New England Journal of Medicine. 368 (17): 1625–1634. doi:10.1056/NEJMcp1208814. ISSN 0028-4793. PMID 23614588. S2CID 1912215. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:16" class="footnote-back-ref">↩</a></p></li> <li id="fn:17"><p>Lynch, Peter J. (2004-01-01). "Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital region". Dermatologic Therapy. 17 (1): 8–19. doi:10.1111/j.1396-0296.2004.04002.x. ISSN 1396-0296. PMID 14756886. S2CID 22038447. <a href="https://doi.org/10.1111%2Fj.1396-0296.2004.04002.x" target="_blank">https://doi.org/10.1111%2Fj.1396-0296.2004.04002.x</a> <a href="#fnref:17" class="footnote-back-ref">↩</a></p></li> </ol>