A pruritic eruption following a farming accident

He had a similar lesion on his thigh a few months ago

A 62-year-old male presents with this severely pruritic cutaneous eruption. Two weeks ago, the top of a tractor fell on his back so he thought this was a reaction to the trauma. Do you recognize this?

This case was shared by a family medicine physician in the Figure 1 community. Below is a valuable discussion between physicians, where a dermatologist was able to assist in the diagnosis of this case.

Dermatologist 1: Nostalgia paresthetica with secondary lichen amyloid, rather than the more typical macular amyloid.

Dermatologist 2: Notalgia parasthetica is the first differential diagnosis coming up to my mind, but there is no sign of scratching due to severe pruritus?!

Family medician physician: Now it makes sense: his pruritus improved with capsaicin but the symptoms overall improved with physical therapy for the trauma on his neck! Thanks!

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