Vulvar lichen simplex chronicus is a common dermatosis characterized by skin lichenification following excessive scratching. It is the end stage of an itch-scratch-itch cycle. The skin is thickened, erythematous, pale, or pigmented, with accentuated markings with normal skin (hatch markings). Once LSC has developed, it causes pruritus even without an alternative source, thus encouraging further scratching and continued worsening of the LSC in what is known as the “itch-scratch cycle.” Lichen simplex chronicus can be a primary dermatosis (the process arising de novo from normal skin), or secondary, presenting as a reaction to another vulvar disease, like lichen sclerosus, psoriasis, contact dermatitis, etc. Diagnosis of LSC is usually established on a clinical basis. Sometimes biopsy will be necessary to exclude underlying pathology. Treatment is aimed at identifying and eliminating the underlying cause, restoring the damaged epithelial barrier, and calming the inflammation with corticosteroids and other means. Even after the clearance of lesions, the condition can relapse. Some patients will need repeated management. Education of the patient is of utmost importance.
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