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Lichen sclerosis et atrophicus (LSA) is a chronic inşammatory dermatosis that is an uncommon but distinctive chronic cutaneous disease of unknown origin. LSA is characterized by white, şat papules with an erythematous halo and black, hard follicular plugs. The trunk and extremities may be affected; the disease has predilection for the vulva, perianal area and groin. The primary signs of vulvar dystrophy are likely to be one or more patches of thick and dry skin; often accompanied by resistant itching Koebner phenomenon was suggested to be associated with LSA. Thus, itch may be a causal factor of LSA. Particularly in genital LSA, local urogenital irritants may be modified with psychological factors leading to resistant itching on the genital area. On the other hand, itch can be associated with libidinal impulses. This is called cutaneous orgasm. A 64 year-old female was admitted to our dermatology outpatient clinic with pruritus and stinging sensations on her anogenital regions 5 years ago for the first time. In dermatologic examination showed a whitish area on the vulvar area. LSA prediagnosis was made and it was confirmed by skin biopsy. The patient was treated with various dermatologic medications for LSA. However, she did not respond to therapies completely and each time only temporary relief was obtained. She was hospitalized for 3 times. We observed that lesions were exacerbated with severe and uncontrollable itch each time. Psychological status was evaluated then and in her history, it is learned that she was given up for adoption by her parents when she was 4 years old, and was raped when she was 19. Afterwards, with an unwanted marriage, she had two daughters and now she lives alone after her husband’s death. On clinical observation, the patient had difficulty in setting boundary at sharing her disease with other patients and she exhibited her body easily. Hysterical expression and focus on phallic objects in the Rorschach test were quite remarkable. In this period, the patient was started SSRI drugs for her anxiety symptoms due to forbearing herself from scratching. Although partial improvement was obtained, there was no complete remission. After 2 years with a diagnosis of vulvar SCC patients were surgically. After vulvectomy itch has spread to other parts of the patient’s body and anal region. The patient complained about sleep disturbance and anxiety symptoms due to her elevated libido. This time sulpiride 50 mg/day started and psychotherapies continued. Two months after patient’s symptoms eased and sleep was improved. The common idea of SCC is that it is caused by chronic tissue damage from itching and starching. Although itching does not alone cause to SCC but it accelerate chronic inşammation and may make easier the occurrence of SCC. There are many biological factors that affect chronic evolution and prognosis of the skin diseases. Doctors can particularly consider metabolic, infectious, nutritional and immunological effects and may ignore the possible psychological factors. This situation can lead to a misperception of any disease to be incurable. Therefore, it is important to evaluate patients in all aspects to make any therapy more effective.