<s>[INST] Hi doctor, I have a small formation in my leg which developed approximately before three years. I have attached the images for your reference. It is brown in color, somewhat similar to a burn. It itches sometimes and it is very dry in nature. This formation was initially around 2 cm, but now has increased in size to 7 cm, which is the reason of my concern. Whenever it itches I only use antiseptic lotions - Suthol. Besides, I have Parkinson's disease and I take sleeping pill every night. Please advice. [/INST] Hi. I have seen your pictures (attachment removed to protect patient identity) and well understand your concern. You are having lichen simplex chronicus (LSC). It arises because of repetitive scratching or rubbing. I could see thickening of the skin with variable flakes. Lichen simplex chronicus usually described as stable, itchy and thickened one or more areas. However, thickening of the skin occurs on any location that the patient can reach, like nape of neck, extensor forearms and elbows, scrotum, upper medial thighs, knees, lower legs and ankles. In your case it involves extensor aspects of ankles. Cause for LSC includes age related dryness, venous insufficiency like tortuous veins or pooling of bloods due to prolong standing or weakness of blood vessels wall due to aging and eczema in old age due to bath with hot water (asteatotic eczema) are common factors. 1. Age related dryness. 2. Venous insufficiency like tortuous veins. 3. Pooling of bloods due to prolong standing. 4. Weakness of blood vessels wall due to aging. 5. Eczema in old age due to bath with hot water (asteatotic eczema). Skin biopsy for histopathological examinations and serum immunoglobulin E. 1. Lichen simplex chronicus. 2. Neurodermatitis. Lichen simplex chronicus. 1. Apply Xerina cream (Glycolic acid) or Moisturex cream (combination of Urea, Liquid Paraffin, Propylene glycol and Lactic acid). Wait for 15 minutes and then apply topical steroids with Salicylic acid should be applied twice daily for two to four weeks and also take one tablet Levocetirizine once daily for similar duration. 2. Propysalic NF lotion (Clobetasol and Salicylic acid combination) occlusive dressing will be more helpful. The method of occlusion is after application of Propysalic lotion put flat polythene cover then cotton bandage and leave it for whole night for two to three days, occlusion is not need in day time. 3. You can also try injection Kenacort (Triamcinolone acetonide) 10 mg/ml 0.1 ml/cm^2 intralesional at the three weeks interval should be given by dermatologist. Try to avoid scratching. Whenever you feel itch apply moisturizer or dip wet cotton in normal tap water and put over it. Revert back after a month to a dermatologist online.---> </s>