What next for these wounds that won’t respond to steroids?
A 63-year-old male presents with an eight-year history of pruritic, crusty wounds on his calves, which then spread to his thighs.
A biopsy six months ago showed features of lichen simplex. He has tried steroid creams with no success.
On examination, there are erythematous-violaceous hyperkeratotic plaques on the calves bilaterally (figure 1) and some similar smaller, flat-topped, polygonal papules and plaques on the upper thigh. The rest of the skin looks normal.
There are no mucosal changes but some of the fingernails show evidence of forward growth of the eponychium with adherence of the proximal nail plate (figure 2).
