From the Research
Leukoderma from lichen simplex chronicus should be treated with topical corticosteroids as the first line of treatment, and for stubborn cases, intralesional triamcinolone injections may be necessary, with repigmentation treatments like tacrolimus 0.1% ointment considered once scratching is controlled, as evidenced by the most recent and highest quality study 1.
Treatment Approach
The primary goal in treating leukoderma from lichen simplex chronicus is to break the itch-scratch cycle and address both the underlying condition and the resulting pigmentation changes.
- Topical corticosteroids, such as clobetasol 0.05% cream, applied twice daily for 2-4 weeks, are effective in reducing inflammation and itching 1.
- For cases that are resistant to topical treatments, intralesional triamcinolone (5-10 mg/ml) injections may be considered to further reduce inflammation and prevent scratching 2.
- Antihistamines like hydroxyzine 25-50mg at bedtime can be helpful in preventing scratching, especially at night 3.
Repigmentation
Once the scratching is controlled, repigmentation treatments can be considered to restore skin color.
- Tacrolimus 0.1% ointment applied twice daily for several months may help in repigmentation, as it has been shown to be effective in treating lichen simplex chronicus and potentially aiding in repigmentation 3.
- Covering the affected area with occlusive dressings or wearing cotton gloves at night can prevent unconscious scratching and aid in the healing process.
Pathophysiology
Leukoderma from lichen simplex chronicus occurs due to chronic scratching and irritation, which damages melanocytes (pigment-producing cells) in the skin, leading to hypopigmentation 4. With consistent treatment and elimination of the scratching behavior, some repigmentation may occur naturally over time, though complete color restoration isn't always possible. The most recent study 1 provides the strongest evidence for the treatment approach, highlighting the importance of topical corticosteroids and the potential benefits of other treatments like tacrolimus for repigmentation.