Emmanuel M. Ozzy
Lichen simplex chronicus has been defined as a localized skin condition resulting in thickening and hyperpigmentation, characterized by accentuated and exaggerated skin markings with excoriations from repeated scratching, usually presenting in a demarcated often circumscribed area of skin. It has even been defined as “psychogenic pruritic disorder”, hence the name ‘neurodermatitis circumscripta’. Its pathophysiology remains unclear but several etiologies have been suggested, including strong links with mental disorders – anxiety and obsessive compulsive disorder. We report this case to highlight the value of an open-minded approach to patients and the ‘good-old’ physician character of empathy and detailed history taking and physical examination skill, and to suggest that lichen simplex chronicus may not always present as ‘circumscripta’ or demarcated area of skin. Case Description: When a sixty-five year-old Caucasian female presented to our clinic agitated, complaining of severe itching and intensely scratching her body, an open-minded approach during history taking and detailed physical examination led to the working diagnosis of diffuse lichenification from chronic scratching due to possible “cutaneous disease condition”. Her medical history was unremarkable but her Psychiatric history was significant for Anxiety Disorder. Patient reported living with the presenting symptoms outlined above for over 9months. After reviewing previous unremarkable results, and remarkable findings on close skin inspection,