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Lichen Simplex Chronicus       

Rubbing or scratching can lead to a type of dermatitis known as LSC or Lichen simplex chronicus. This dermatitis is a localized form of lichenification (leathery texture) that occurs in circumscribed plaques either generalized or localized. This is also known as neurodermatitis which is a common skin problem affecting adults that lasts for decades. Children too exhibit the same lesions especially in mentally retarded children who have chronic repetitive movements. Although the source of the itch is yet unknown, it may result from insect bites, from stress or simply from a nervous habit.

The cause of the skin disorder arises from a self-perpetuating scratch-itch cycle. This means that it may begin with something rubbing or scratching the skin like clothing. This will then lead to the person scratching the area affected resulting to the skin becoming thicker. The thickened skin itches causing the person to scratch even more until there's more thickening of the skin. As the scratch-itch cycle continues, the skin will end up becoming leathery and brownish.

The lichen simplex is also associated with atopic dermatitis (eczema) or psoriasis. Also associated with the condition is nervousness, anxiety, depression, and other psychological disorders.

Itching and the formation of skin lesions or patches with a history of chronic itching and scratching are the signs and symptoms of the disease. Itching of the skin may be chronic and intense that increases with nervous tension and stress. While the skin lesions are exaggerated skin lines over the lesion with distinct borders and lichenification making the skin darken (hyperpigmented) or redden. The lesion will exhibit scratch marks and abrasions as well as scaling. These are commonly located at the wrist, neck, forearms, thighs, rectum/anal area, ankle, lower leg, back of the knee and the inner elbow.

To diagnose this disease, a skin lesion biopsy is needed for confirmation. To treat the disease, the scratching has to stop primarily. For this, the patient has to undergo counseling for the importance of not scratching, undergo stress management, or even behavior modification.

The itching and inflammation can be treated with the application of peeling ointments containing salicylic acid, soaps or lotions containing coal tar, antihistamines, steroid injections, sedatives, or tranquilizers to reduce itching and stress.

Prognosis for this disease will depend on the level of stress and scratching of the patient. There is however a tendency for the disease to return or even change location. So just scratch gently.