A 30-year-old Pakistani man presents with gradual development of extremely itchy lesions on both legs in a more or less symmetric distribution.
Key point: These thickened plaques show a violaceous color where secondary changes from rubbing and scratching are minimal. This morphology is good for hypertrophic lichen planus, appearing in its typical location.
Treatment: If simple application of an ultrapotent steroid does not lead to resolution, then intralesional injection of dilute triamcinolone acetonide (2 to 5 mg/mL) would be the next treatment option.
Note: Hypertrophic lichen planus almost universally appears in those with darker skin tones, and should be considered in the differential of any pruritic eruption involving the shins.