Abstract: . . .  the base of the penis. There is persistent itching, burning or pain. The cause is unknown and it is resistant to treatment. 36 TREATMENT. The patient must first understand that the rash will not clear until even minor scratching and rubbing is stopped. Scratching frequently takes place during sleep, and the affected area may have to be covered. Lichen simplex chronicus is chronic eczema and is treated as outlined in the section on eczematous inflammation. Treatment of the anal area or the fold behind the ear does not require potent topi- cal steroids as do other forms of lichen simplex; rather, these intertriginous areas respond to Group V or VI topical steroids. Lichen simplex nuchae, because of its location, is difficult to treat. Dry inflammation that extends into the scalp may be treated with a Group II steroid gel such as fluo- cinonide (Lidex) applied twice each day. Moist, secondarily . . .
. . .  topical treatment. Nodules caused by picking at the scalp may be very resistant to treatment, requiring monthly intralesional injections with triamcinolone acetonide (Kenalog 10 mg/ml). Botulinum toxin A injected intrader- mally into lichenified lesions may block acetylcholine release and control pruritis. Pruritus subsided within 3 to 7 days and lesions cleared in 2 to 4 weeks. 37 Clinical Dermatology 64 Table 3-4 Self-Inflicted and Self-Perpetuated Dermatoses Dermatologic complaint that is a primary Dermatologic psychiatric s . . .
. . .  those that are conveniently reached. These are listed in Box 3-6 (Lichen Simplex Chronicus: Areas Most Commonly Affected Listed in Approximate Order of Frequency) in approximate order of frequency. Patients derive great pleasure in the relief that comes with frantically scratching the inflamed site. Loss of this pleasurable sensation or continued subconscious habitual scratching may explain why this eruption frequently recurs. Chapter 3 Eczema and Hand Dermatitis 63 Box 3-6 Lichen Simplex Chronicus: Areas Most Commonly Affected Listed in Approximate Order of Frequency Outer lower portion of lower leg Scrotum, vulva, anal area, pubis Wrists and ankles Upper eyelids Back (lichen simplex nuchae) and side of neck Orifice of the ear Extensor forearms near elbow Fold behind the ear Scalp-pickers nodules Figure 3-43 Lichen simplex chronicus of the vulva. . . .
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