In January 2016 she was referred to our clinic with widespread dry skin with lichenification
and multiple excoriations (SCORAD 48), despite cyclosporine A treatment.
Atopic dermatitis is a chronic, eczematous skin disease caused by a disequilibrium in the interaction between immune and skin barrier systems, and resulting in the formation of erythematous plaques, eruption, lichenification
accompanied by pruritus, and cutaneous hypersensitivity (Otsuka et al., 2017).
Other common morphologies were urticaria, scaling, nummular eczema, lichenification
, plaques, pustules, erosions, hypo-and hyperpigmentation.
On the other hand, chronic irritant CD is characterized by diffuse or localized lesions with typically poorly defined erythematous scaly patches and plaques, dryness of skin, lichenification
and desquamation (2).
 For disease intensity (B), the primary investigator assessed six clinical signs--erythema, oedema/ induration, excoriation, lichenification
, oozing/crusting and dryness (xerosis)--at a single representative site (the most affected).
The severity of vesicle, hypo- and hyper-pigmentation, erythema, lichenification
, fissure, and excoriation did not change by pimecrolimus or betamethasone administration.
With more advanced disease, erosions, lichenification
, and even distortion of vulvar architecture may occur.
can be present, which is a leathery thickened condition secondary to repeated scratching.
Whole-body examination revealed active AD on the backs of the knees with ill-defined erythematous patches with scaling, lichenification
, and excoriations (Figure 2).
The skin was dry with flexural lichenification
. The scalp hair was short, brittle, and sparse.
is one of the symptomatic hallmarks of AD that is characterized by skin thickening of the epidermal tissues .
At physical examination we also discovered multiple excoriations extended on his entire body, with areas of lichenification
. The patient was apyretic and he was complaining of intense pruritus.