Q. A 52-year-old man comes to the clinic for severe itching in the elbow and knee creases for the last six months. He has a long-standing history of atopic dermatitis and has been using emollients regularly and low-potency topical corticosteroids during the flares. His vitals are stable. On examination, the skin in the affected areas is hyperpigmented and thickened, with accentuated skin lines giving it a leathery appearance. Which of the following best explains this observation?