lichen planus and porokeratosis of Mibelli

Figure 1: MRI showing cervical disc prolapse (C5–6) and hypertrophied ligamentum ß avum middle and ring fingers, which had been mistakenly attributed to scabies by another dermatologist and given topical parasiticidal medication in vain. The localized pruritus used to come in bouts (not seasonal) and had significantly disturbed the patient over many months. The patient’s past medical history was unremarkable. On examination, the skin was normal and there were no abnormal neurological signs. Alloknesis (Gk allos other, knēsis scratching) or itch produced by innocuous mechanical stimulation was absent. Adjacent dermatomes on the palm overlap considerably; however, the patient’s localization of the itch suggested involvement of palmar C6 and C7 dermatomes. No specific diagnosis was made then. A skin biopsy was not performed and I suggested the use of emollient, oral non-sedating antihistamine and watchful waiting for any possible changes in the symptom. Few months later, the patient developed numbness of the right upper and lower limbs. It was clear then that neurosurgery consultation was urgently required. Magnetic resonance imaging (MRI) showed cervical disc prolapse (C5–6) and hypertrophied ligamentum flavum [Figure 1]. Cervical discectomy via anterior approach was performed on the case. Unfortunately, the operation was not that helpful and the patient developed bilateral upper and lower limbs pain few months later. A second operation was performed to decompress the spinal cord via posterior approach cutting the hypertrophied ligamentum flavum. All symptoms disappeared shortly thereafter.