This is the base of the neck posteriorly. It is a common
site for stress induced scratching. When skin is rubbed or scratched repeatedly
it thickens or lichenifies. Sometimes the skin markings just become more
prominent but in other cases grouped papules and nodules are formed. This is
more common in people of an Asian background with a history of atopic eczema.
Unless the itch scratch cycle is broken this rash will persist indefinitely.
You need to use a very strong topical steroid such as Diprosone OV cream or
ointment to break that cycle by reducing the itch. Another option is to use
diluted intra lesional Kenacort A10 with 1ml of solution to 3 mls of local anaesthetic.
A small amount is injected intradermally at 1 cm intervals covering the area.
This slowly diffuses over a 4 week period reducing the itch and the skin
thickening. It helps to point out the cause and to instigate measures to help
with the underlying stress.
