Initially, the lesions were scattered small papules, which later thickened, flaked, and spread. The skin around these lesions became darker, dry, and cracked. He previously received treatment at a medical facility using liquid nitrogen spray, but improvement was slow, and relapses were persistent.

At Tam Anh General Hospital, Ho Chi Minh City, Master of Science, Doctor Vu Thi Thuy Trang, a specialist in Dermatology - Aesthetic Dermatology, observed numerous hard, hyperkeratotic, dark brown papules, 2-3 cm in diameter, on the patient's limbs, along with signs of prolonged inflammation from scratching. Some areas showed clear hyperkeratosis and hyperpigmentation, indicating the lesions had been present for a long time.

According to Doctor Trang, this is a chronic inflammatory condition where itchy papules appear when the skin is irritated (allergies, insect bites, dry skin), causing the local immune system to release inflammatory substances (such as histamine), which activate nerve endings, leading to itching and red papules. When scratched, the skin becomes abraded and more inflamed, increasing the itch and creating a "itch-scratch-inflammation" cycle, causing the papules to persist, thicken, and easily recur.

Doctors inject triamcinolone to control inflammation and reduce itching for Mr. Hau. *Photo: Tam Anh General Hospital*.

Doctors prescribed internal medicine treatment to control inflammation and reduce itching by injecting triamcinolone (a corticosteroid) three to five times, once a month, combined with monitoring the response and limiting scratching. Injecting triamcinolone directly into the lesions typically reduces inflammation and itching, flattens thickened papules more effectively, and causes fewer burns, ulcers, or white spots from freezing compared to liquid nitrogen spray. After two injections, Mr. Hau's itching significantly decreased, his hyperkeratotic skin patches stabilized, and his sleep quality improved.

The itchy papules were no longer hyperkeratotic or itchy after three triamcinolone injections. *Photo: Tam Anh General Hospital*.

Doctor Trang noted that many people often underestimate skin lesions accompanied by prolonged itching, dismissing them as common skin conditions. However, chronic itchy papules with hyperkeratosis can affect quality of life and appearance. Self-diagnosis and incorrect treatment can prolong the condition and spread lesions.

When persistent itching, hyperkeratotic lesions, and flaking skin do not respond to conventional treatment, patients should visit a hospital with a Dermatology department for proper examination and treatment.

Minh Huong

*Patient's name has been changed