Patient Case: Lichen Simplex
A 42-year-old woman presents with a three-month history of an intensely itchy, thickened patch on the left side of her neck. She reports that the itching is worse at night and that she often finds herself scratching unconsciously, especially during stressful moments. She has tried applying over-the-counter moisturizers, but the itch persists.
She has a history of mild anxiety but no known allergies, eczema, or psoriasis. She denies using new skincare products, and no other areas of her body are affected.
On examination, there is a well-defined, hyperpigmented, leathery plaque with exaggerated skin lines on the lateral side of her neck. No signs of infection, scaling, or oozing are present. A clinical diagnosis of lichen simplex chronicus (neurodermatitis) is made, likely triggered by chronic scratching due to habitual itching.
She is advised to break the itch-scratch cycle with topical corticosteroids, antihistamines, and behavioral modifications. Emollients are recommended to keep the area moisturized, and stress-reduction techniques are discussed to prevent recurrence.
a) Atopic dermatitis
b) Lichen simplex chronicus
c) Psoriasis
d) Contact dermatitis
a) Chronic scratching or rubbing
b) Autoimmune skin reaction
c) Bacterial skin infection
d) Exposure to an irritant or allergen
a) High-potency topical corticosteroids and antihistamines
b) Systemic immunosuppressants
c) Oral antibiotics and antifungals
d) Daily exfoliation and use of strong moisturizers
a) Identifying and avoiding triggers such as stress or anxiety
b) Applying topical steroids continuously for months
c) Scrubbing the area aggressively to remove thickened skin
d) Using systemic corticosteroids as a long-term solution
