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Increased risk of lichen simplex chronicus in people with anxiety disorder: a nationwide population-based retrospective cohort study*.
Liao, Y.-H. 1,2; Lin, C.-C. 3,4; Tsai, P.-P. 1,2; Shen, W.-C. 1,5; Sung, F.-C. 3,4; Kao, C.-H. 2,6
[Miscellaneous Article] British Journal of Dermatology. 170(4):890-894, April 2014.

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Background: The cingulate cortex is the main area in the brain involved in pruritus processing and is deactivated after scratching. Lichen simplex chronicus (LSC) is a common pruritic skin disorder characterized by skin lichenification following excessive scratching. Psychological factors may contribute to both the development and persistence of LSC.

Objectives: To estimate the hazard ratio (HR) of LSC in people with anxiety disorders compared with the general population.

Methods: In this nationwide population-based retrospective cohort study we identified a total of 69 386 people, who formed the anxiety cohort, by using the Taiwan National Health Insurance Research Database from 2000 to 2009. The comparison cohort was composed of randomly selected people frequency matched for age (within 5-year intervals), sex and index date (the date of anxiety diagnosis) based on a 1: 2 ratio. The risk of LSC was estimated as HRs and 95% confidence intervals (CIs) using the Cox proportional hazards model.

Results: After adjusting for age, sex and LSC-associated comorbidities, the people with anxiety had a 1[middle dot]41-fold greater risk of developing LSC compared with the people in the comparison cohort (HR 1[middle dot]41, 95% CI 1[middle dot]30-1[middle dot]52, P < 0[middle dot]0001). In particular, individuals with obsessive-compulsive disorder had a significantly increased risk of developing LSC (HR 1[middle dot]72, 95% CI 1[middle dot]03-2[middle dot]88, P = 0[middle dot]0395).

Conclusions: This study demonstrates that having an anxiety disorder is associated with an increased risk of LSC. Psychological factors were found to contribute to LSC. We recommend combining the management of LSC and psychological disorders to achieve favourable outcomes.

What's already known about this topic?:

* Lichen simplex chronicus (LSC) is a common skin disorder characterized by skin lichenification following excessive scratching.

* LSC is not a life-threatening disease, but it can result in psychosocial problems and impair quality of life through sleep disturbance and sexual dysfunction.

What does this study add?:

* This study demonstrates that people with anxiety, especially those aged < 40 years, are at an increased risk of having LSC. Psychological factors were found to contribute to LSC.

* We recommend combining the management of LSC and psychological disorders to achieve favourable outcomes.