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75-Year-Old Male with Persistent, Pruritic Plaque on Shin

Can you diagnose this case?

David L. Kaplan 2014 Series Editor @ University of Missouri – Kansas City School of Medicine

Signs and Symptoms

A persistent, pruritic plaque on one shin has bothered a 75-year-old man for 5 years. Over-the-counter preparations have not resolved the lesion.

What kind of eruption is this?

Choose one to reveal diagnosis and discussion

Stasis dermatitis
Dermatophyte infection
Impetigo with cellulitis
Candida infection
Lichen simplex chronicus

Answer: Lichen simplex chronicus

See the full case at Consultant360

This excoriated plaque is lichen simplex chronicus, which is often referred to as “the itch that rashes.” This self-inflicted dermatosis is frequently triggered by a precipitating factor. To confirm the diagnosis, occlude the lesion so that the patient has no access to the area and examine it 1 or 2 weeks later. Invariably, significant healing will have occurred because the lesion was not rubbed or scratched. Occasionally, particularly in patients with long-standing disease, it is not possible to identify the inciting cause of the chronic itch/scratch cycle. However, it is reasonable to search for underlying chronic disease, such as venous insufficiency, myxedema, or xerosis. Tailor treatment to the inciting disorder. This patient had long-standing xerosis; a corticosteroid cream, and occlusive dressings, ameliorated the pruritic skin condition.

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