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Dermatology/Hard, Dark skin in Foreskin

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Question
Hard Darkened spot
Hard Darkened spot  

Hard Darkened spot
Hard Darkened spot  
Long time ago a mild colored patch appeared in my foreskin, at the beginning it was very tiny and barely noticeable, so i let it passed, maybe about a half a year ago; the dark spot began to become more darkened and rough to the touch, now it hurts a little bit. I would really like to know what it is? And if it is an infection or such as, what would be the treatment?

Answer
Lichen simplex chronicus is a skin disorder that leads to chronic itching and scratching.
Causes, incidence, and risk factors
This disorder may occur in people who have:
Eczema (atopic dermatitis)
Psoriasis

Nervousness, anxiety, depression, and other psychologic disorders
It is common in adults, who cannot stop scratching insect bites and other itchy skin conditions. It can also be common in children who have chronic repetitive movements.
Symptoms
This skin disorder leads to a scratch-itch cycle:
It may begin with something that rubs, irritates, or scratches the skin, such as clothing.
This causes the person to rub or scratch the affected area. Constant scratching causes the skin to thicken.
The thickened skin itches, causing more scratching, which causes more thickening.
The skin may become leathery and brownish in the affected area.
Symptoms include:
Itching of the skin
May be long-term (chronic)
May be intense
Increases with nervous tension, stress
Skin lesion, patch, or plaque
Commonly located on the ankle, wrist, neck, rectum/anal area, forearms, thighs, lower leg, back of the knee, inner elbow
Exaggerated skin lines over the lesion
Distinct borders to the lesion
Becomes leathery in texture (lichenification)
Darkened (hyperpigmented) or reddened skin
Raw areas
Scratch marks
Scaling

Signs and tests
The diagnosis is primarily based on the appearance of the skin and a history of chronic itching and scratching. A skin lesion biopsy may be needed to confirm the diagnosis.
Treatment
The primary treatment is to stop scratching the skin. This may include counseling to become aware of the importance of not scratching, stress management, or behavior modification.
The itching and inflammation may be treated with a lotion or steroid cream applied to the affected area of the skin. Peeling ointments, such as those containing salicylic acid, may be used on thickened lesions. Soaps or lotions containing coal tar may be recommended.
Dressings that moisturize, cover, and protect the area may be used with or without medication creams. They are left in place for a week or more at a time.
Antihistamines, sedatives, or tranquilizers may be needed to reduce itching and stress. Steroids may be injected directly into lesions to reduce itching and inflammation.
Patients who have an emotional component to their lichen simplex chronicus may need antidepressants and tranquilizers.
Expectations (prognosis)
You can control lichen simplex chronicus by reducing stress and scratching less. The condition may return or change sites.
Complications
Bacterial skin infection
Permanent changes in skin color
Permanent scar

Dermatology

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Michael S. Fisher, <B>Ph.D., M.D.</B>

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