History:

 This presentation is seen in old lonely depressed people who have got extreme pruritus all over the body especially on easily accessible area and mainly on the back. Lesions are excoriated  hyperpigmented papules and nodules which heal with hypopigmentation in the center. Face is usually spared. There is typical sparing of mid back which is not easily accessible area .(rhomboid sign).Diagnosis is by typical lesions over typical area and by ruling out other organic causes . It responds well to antidepressants and/or antipsychotics.