What is causing an itching and thick patch on my skin at 19?

Question

Hello, Doctor,

I am a 19-year-old female, and I have developed a thick, dry, discolored patch on the top of my foot over the past two months. The skin feels rough, and there is intense itching that worsens whenever the area comes into contact with dust or dirt. The itching can be quite uncomfortable at times.

I have already tried using Betamethasone 0.1% ointment as well as a combination cream containing Econazole Nitrate and Triamcinolone Acetonide, but neither of these treatments has resolved the issue. I am concerned about what this condition might be, and I would like to know whether it could be eczema, contact dermatitis, lichen simplex chronicus, psoriasis, or a fungal infection.

I am also wondering if the use of steroid-containing creams could have altered the appearance of the condition or made a fungal infection harder to recognize. Please tell me,

What is causing this?
What steps should I take for investigations and treatment?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Based on your symptoms, the most likely diagnosis of your symptoms is lichen simplex chronicus. This is because lichen simplex chronicus happens when repeated scratching or rubbing causes the skin to become:

Thick and leathery.
Dry and rough.
Darker or discolored.
Very itchy, especially when irritated by things like dust, dirt, or friction.

Your patch has been present for 2 months, is thick, dry, discolored, and intensely itchy, which is very typical for this condition. Also, the localized thick, itchy plaque on the foot with itch–scratch cycle strongly points to lichen simplex.

You are using the following medications for this,

Betamethasone (strong steroid).
Econazole with Triamcinolone.

These medicines usually help eczema or fungal infections, but if scratching continues, the skin may stay thick and itchy.

You should follow the steps mentioned below to

Stop the itch and scratch cycle. You should keep your nails short and try not to rub the area.
Apply moisturizer frequently. Also, apply thick creams or petroleum jelly 2–3 times daily.
Doctors sometimes prescribe stronger steroid creams for a short time, and anti-itch medicines at night.
You must protect the skin and avoid dust and irritants from touching the area.
You can wear soft socks if the friction worsens.

I hope this information helps you.

Feel free to ask further queries.

Thank you.