“Can I get off cortisone?” was the plaintiff plea of this new patient. “It makes my face so puffy.” She was fifty-one years of age and had suffered a terrible widespread itch since she was twenty-eight years old. It tore holes in her stockings. It kept her awake nights.

She had been told it was due to stress. She was serving on too many committees. “Relax and the itch will go away,” but it did not. It followed her to what should have been pleasant carefree Caribbean vacations. It followed her on her move halfway across the country to a new home. As we watched her scratch, we realized it had followed her into our office. Topical creams, lotions, and sprays were only momentary distractions. Her fingernails were polished from incessant scratching. And, the more she scratched, the more the new spots appeared.

There was no mystery as to her diagnosis. She had generalized lichen planus, now a twenty-three year itch. It had been repeatedly diagnosed clinically and histologically by a half dozen doctors. She had been told that no cause is known and cortisone could give her relief. And it had, but she wanted to escape the side effects of the cortisone she had been taking for so many years. Despite her edematous face and the bulge on the nape of her neck, we could find none of the more serious side effects of cortisone, such as hypertension, peptic ulcer, or osteoporosis.