Scrotal lichen simplex chronicus triggered by an insect bite: a case report with neuroimmune pathophysiological insights

Lichen simplex chronicus (LSC) is a chronic pruritic disorder characterized by localized lichenification resulting from a persistent itch-scratch cycle.We report a 73-year-old male farmer with type 2 diabetes mellitus who presented with a 30-year history of severe scrotal pruritus.Symptoms began approximately 2 months after a documented insect bite in the scrotal region.Examination revealed a linear hypertrophic plaque with central ulceration on lichenified, hyperpigmented skin.Dermoscopy showed polymorphic vessels, ulceration, red globules, and structureless white areas.Histopathology confirmed LSC.Treatment with high-potency topical corticosteroids, local anesthetic cream, and emollients resulted in partial improvement.Insect bites may initiate persistent itch through acute inflammation and activation of cutaneous pruriceptors, potentially leading to neuroimmune dysregulation in predisposed individuals.This case highlights a possible neuroimmune link between an insect bite and chronic scrotal pruritus.