History:

The ankle region is one of the predilection sites of lichen simplex chronicus, which is an eczematous dermatitis that may be precipitated, perpetuated and exacerbated by psychological upsets. It usually affects adults and elderly people and characterized by intense paroxysmal itching. It is usually confined to one area; however multiple sites or bilateral areas are not uncommonly encountered in clinical practice like the presented  lady who has had pruritic bilateral hyperpigmented lichenified plaques with exaggerated skin lines involved both ankles of 5 years duration.