History:

Patient of Dr

Typical linear excoriations on the lower leg and back beginning with a stressful situation and perpetuated by some psychological or medical gain.

d take a full history, do a mental state exam, and complete a validated distress scale such as K10. If depressed or anxious, which is most likely the case, my first choice treatment would be doxepin which is antipruritic as well as an antidepressant.