From the Guidelines
Lichen Simplex Chronicus (LSC) should be treated with ultrapotent topical corticosteroids, such as clobetasol propionate 0.05%, as the first-line therapy to reduce inflammation and break the itch-scratch cycle. The treatment regimen recommended is clobetasol propionate 0.05% ointment applied once daily, at night, for 4 weeks, then on alternate nights for 4 weeks, and then twice weekly for a further 4 weeks, before review 1. This approach is based on the most recent guidelines from the British Association of Dermatologists, which suggest that an ultrapotent topical corticosteroid is the first-line treatment for LSC, despite the lack of randomized controlled trials comparing steroid potency, frequency of application, and duration of treatment 2, 3.
Key Considerations for Treatment
- The use of clobetasol propionate 0.05% has been shown to be safe and effective in the long-term management of LSC, with about 60% of patients experiencing complete remission of their symptoms 2.
- For patients with ongoing active disease, continued use of clobetasol propionate 0.05% is recommended, with the treatment regimen individualized to maintain disease control and prevent scarring 1.
- Intralesional triamcinolone acetonide (10–20 mg) may be considered for patients with topical steroid-resistant, hyperkeratotic areas, after excluding intraepithelial neoplasia or malignancy by biopsy 1.
- Identifying and addressing triggers such as stress, anxiety, or contact irritants is crucial for long-term management of LSC.
Additional Therapies
- Sedating antihistamines like hydroxyzine 25-50mg at bedtime can help prevent unconscious scratching and reduce nighttime itching.
- Applying moisturizers containing ceramides or colloidal oatmeal immediately after bathing helps maintain skin hydration and reduce inflammation.
- Occlusion of the affected area with plastic wrap after applying corticosteroids can enhance penetration and improve treatment outcomes.
From the Research
Diagnosis of Lichen Simplex Chronicus (LSC)
- LSC is a disorder characterized by thickened areas of skin from repeated rubbing or scratching 4
- The condition is clinically characterized by typical lichenoid lesions, severe itching, and scratching 5
Treatment of Lichen Simplex Chronicus (LSC)
- Topical corticosteroids are often used to treat LSC, with the most robust evidence seen in 7 RCTs 4
- Other treatments that may be beneficial include: + Topical immunomodulators + Topical antipruritic agents + Oral antihistamines + Antiepileptics + Antidepressants 4
- Novel treatment approaches that have shown promise include: + Transcutaneous electrical nerve stimulation + Focused ultrasound + Phototherapy 4
- Topical tacrolimus 0.1% ointment has been shown to be an effective, long-lasting therapeutic modality in treating LSC, especially in sensitive skin areas such as the face 5
- Topical aspirin solution with dichloromethane has been found to have a significant antipruritic effect in the treatment of LSC 6
- The use of hydrocolloid dressing with topical steroid, such as 0.1% mometasone furoate, has been shown to be a cost-effective treatment for moderate to severe LSC 7