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What is condition of this skin, it been 5-6months chronic
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lichen simplex chronicus chronic skin lesion treatment itch scratch cycle
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I now have everything needed for a thorough answer. Here it is:
Most Likely Diagnosis: Lichen Simplex Chronicus (LSC)
Also known as circumscribed neurodermatitis, this is a chronic skin condition caused by the repeated habit of scratching or rubbing a localized area of skin over a prolonged period - exactly matching your 5-6 month timeline.
What the image shows
The lesion on your forearm/shin has the classic features of LSC:
- Lichenification - the skin is thickened and leathery, with exaggerated crisscross skin markings forming a "bark-like" or mosaic pattern
- Hyperpigmentation - dusky grayish-brown/purplish discoloration
- Well-demarcated plaque - roughly 3-5 cm, clearly separated from surrounding normal skin
- Fine surface scaling with small pinpoint excoriations (scratch marks) inside the plaque
- Satellite papules around the main plaque - areas of post-inflammatory pigmentation from repeated scratching
Compare your lesion to the textbook image of LSC from Andrews' Diseases of the Skin:
The histology shows compact hyperkeratosis, acanthosis with irregular elongation of rete ridges, and vertically oriented collagen bundles in the papillary dermis.
The Itch-Scratch Cycle
The key mechanism is a self-perpetuating loop:
Itch → Scratch/Rub → Skin thickens → More itch → More scratching
The initial trigger (insect bite, dry skin, contact dermatitis, anxiety, stress) often resolves, but the scratching habit continues and becomes subconscious. After 5-6 months, significant lichenification develops as you are experiencing.
Predisposing factors include: xerosis (dry skin), atopy, anxiety/OCD, localized neuropathic itch, and psoriasis. The condition is also associated with anxiety disorders and depression.
Differential Diagnoses to Rule Out
Given the chronic duration, a dermatologist may want to exclude:
| Condition | Differentiating Feature |
|---|---|
| Hypertrophic lichen planus | Violaceous papules, Wickham's striae |
| Lichen amyloidosis | More rippled/verrucous, favors shins |
| Chronic eczema/atopic dermatitis | More diffuse, personal/family atopy history |
| Psoriasis | Silvery-white thick scales, nail changes |
| Tinea (ringworm) | Active scaly border, KOH positive |
Treatment
The primary goal is breaking the itch-scratch cycle - Andrews' Diseases of the Skin, p. 71:
First-line:
- High-potency topical corticosteroid (e.g. clobetasol 0.05% cream/ointment) initially, then step down to medium-potency as it clears. Do not use indefinitely to avoid steroid atrophy.
- Occlusion of the steroid (covering with a dressing or steroid-impregnated tape) greatly improves penetration.
Adjunct antipruritic therapy:
- Topical tacrolimus ointment or pimecrolimus cream (calcineurin inhibitors)
- Topical doxepin or capsaicin
- Hydrocolloid dressings applied repeatedly - physically prevents scratching and promotes healing
If resistant:
- Intralesional triamcinolone injection 2.5-5 mg/mL (given by dermatologist)
- Oral antihistamines (especially sedating ones at night to reduce nocturnal scratching)
- Gabapentinoids (gabapentin/pregabalin), antidepressants for neuropathic itch component
- Phototherapy (narrowband UVB)
- In severe cases: Unna boot (zinc paste bandage) to break the cycle completely
Behavioral/psychological:
- Patient education about the scratch-thickening-itch cycle is essential
- Cognitive behavioral therapy, habit-reversal techniques
- Addressing underlying anxiety or stress
Important Next Steps
Please see a dermatologist. At 5-6 months, this needs proper assessment to:
- Confirm the diagnosis (rule out tinea, lichen planus, psoriasis)
- Prescribe appropriate-strength topical steroids - the wrong potency can cause skin atrophy
- Check for an underlying trigger (e.g. contact allergy, venous insufficiency if on lower leg)
A skin biopsy may be recommended if the lesion does not respond to initial treatment.
Disclaimer: This is for educational purposes only and is not a substitute for a clinical examination by a licensed dermatologist. Do not self-medicate with high-potency steroids without medical guidance.
I had this type of rash in foot diagnosed as chronic eczema, used mometasone now this in shin bone
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chronic eczema spreading shin mometasone steroid use lichen simplex chronicus treatment
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This is a very important clinical picture now. Here is a thorough update:
Updated Clinical Picture: Chronic Eczema → LSC → Possible Lichen Amyloidosis
This progression you're describing - foot eczema → mometasone use → new shin lesion - tells a significant story. There are three distinct issues to understand here.
1. Why the Lesion Has Spread to the Shin
The shin (anterior tibia) is one of the most classic locations for lichen simplex chronicus, and this is not a coincidence with your history. Two mechanisms are likely:
A. The itch-scratch habit migrated. The foot eczema created an itch-scratch habit. Even after partial control with mometasone, chronic scratching behavior is deeply ingrained - the habit shifts to accessible nearby skin (shins are easily reachable and commonly rubbed). The shin lesion is now its own independent lichenification site.
B. Inadequate control of the original eczema allowed persistent itch, which is being "displaced" to the shin. Mometasone (a medium-to-high potency steroid) works on inflammation but does not address the underlying scratching behavior.
2. The Mometasone Concern - Important Warning
Mometasone furoate is a Group III (medium-high potency) corticosteroid. After months of use, especially on the foot (thin/occlusive area), there are real risks:
- Skin atrophy - thinning, telangiectasias, easy bruising
- Tachyphylaxis - the steroid stops working as well over time, causing rebound itch when stopped
- Striae (stretch marks) with prolonged use
- Tinea incognito - if a fungal infection was contributing to the original foot rash, mometasone suppresses the immune response and allows it to spread while masking the appearance
Key question: Was a KOH scraping or fungal culture done on the original foot rash before starting mometasone? If not, tinea pedis (athlete's foot) misdiagnosed as eczema is a serious possibility - mometasone would have worsened a fungal infection over months.
3. The Serious Risk: Lichen Amyloidosis
This is the most important concern given your location (shin) and timeline. Andrews' Diseases of the Skin explicitly states:
"Persistent rubbing of the shins... may result in dermal deposits of amyloid and the subsequent development of lichen amyloidosis."
Fitzpatrick's Dermatology confirms: lichen amyloidosis classically presents on the shins and forearms as:
- Linear rows of firm, pigmented, hyperkeratotic papules
- Intense paroxysmal pruritus
- More common in darker Fitzpatrick skin types (which matches your skin tone in the image)
- LSC changes may co-exist with it
Textbook image of lichen amyloidosis on the shin for comparison:
Your current lesion looks more like LSC at this stage, but if not treated, it can evolve into lichen amyloidosis - amyloid deposits in the skin that are much harder to treat and largely irreversible.
What You Should Do - Urgently
| Priority | Action |
|---|---|
| 1 - Most urgent | See a dermatologist - do not self-continue mometasone |
| 2 | Request a KOH scrape/fungal culture of the foot lesion to rule out tinea |
| 3 | Ask for a skin biopsy of the shin lesion - this is the only way to confirm LSC vs. early lichen amyloidosis |
| 4 | Discuss stopping or stepping down mometasone with proper tapering |
| 5 | Address the itch-scratch cycle with behavioral techniques + appropriate treatment |
What Will Likely Be Prescribed
Based on the clinical picture and textbook guidance:
-
For the shin LSC:
- High-potency topical steroid (clobetasol) under occlusion (hydrocolloid dressing) - research from 2023 shows mometasone under hydrocolloid dressing is highly effective for LSC
- Topical tacrolimus 0.1% (non-steroid, safe for long-term use)
- Oral antihistamines at night (cetirizine/hydroxyzine) to reduce nocturnal scratching
- If resistant: intralesional triamcinolone injection
-
If lichen amyloidosis is confirmed on biopsy:
- PUVA phototherapy, UVB light
- Oral retinoids or amitriptyline
- Laser therapy (Q-switched Nd:YAG 532 nm) for pigmentation
- Treatment is "frequently unsatisfactory" per Andrews' - early intervention matters
-
If tinea is found:
- Stop mometasone immediately
- Oral antifungal (terbinafine or itraconazole) for 2-4 weeks
The bottom line: The progression from foot eczema to shin lichenification over 5-6 months on mometasone is a red flag that needs a dermatologist review soon. The shin is a high-risk site for lichen amyloidosis, and catching this early makes a meaningful difference in outcome. Please do not continue applying mometasone to new sites without medical guidance.
Disclaimer: This is educational information only and does not replace an in-person clinical examination and diagnosis by a licensed dermatologist.
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