From the Guidelines
Lichen simplex chronicus should be treated with potent topical corticosteroids, such as clobetasol propionate 0.05% ointment, applied once daily for a month, then on alternate days for a month, and finally twice weekly for a month, as this regimen has been shown to be effective in reducing inflammation and breaking the itch-scratch cycle 1. The treatment of lichen simplex chronicus focuses on reducing inflammation and preventing further skin damage.
- The use of ultrapotent topical corticosteroids, such as clobetasol propionate, is recommended as first-line therapy 1.
- The application of clobetasol propionate 0.05% ointment once daily for a month, then on alternate days for a month, and finally twice weekly for a month, has been shown to be effective in reducing inflammation and breaking the itch-scratch cycle 1.
- In addition to topical corticosteroids, addressing the underlying causes of the condition, such as stress and irritants, is crucial for effective management.
- Behavior modification, including keeping nails short and wearing cotton gloves at night, can also help prevent further skin damage.
- For persistent cases, intralesional triamcinolone acetonide injections may be necessary, but this should be considered only after other treatment options have been exhausted 1. The British Association of Dermatologists guidelines for the management of lichen sclerosus, published in 2018, provide a comprehensive approach to the treatment of this condition, including the use of topical corticosteroids and individualized treatment regimens to maintain disease control and prevent scarring 1.
- The guidelines recommend offering all female patients with anogenital lichen sclerosus clobetasol propionate 0.05% ointment on a regimen for 3 months, combined with a soap substitute and a barrier preparation 1.
- The guidelines also emphasize the importance of discussing the amount of topical treatment to be used, the site of application, and the safe use of ultrapotent topical steroids with the patient 1.
From the Research
Definition and Characteristics of Lichen Simplex Chronicus
- Lichen simplex chronicus (LSC) is a disorder characterized by thickened areas of skin from repeated rubbing or scratching 2.
- The multifactorial nature of LSC makes management difficult and there are currently no evidence-based guidelines for treatment 2.
Treatment Options for Lichen Simplex Chronicus
- The most robust evidence was seen with the use of topical corticosteroids (n = 7 RCTs) 2.
- Limited data suggest benefit with other treatments such as topical immunomodulators, topical antipruritic agents, oral antihistamines, antiepileptics and antidepressants 2.
- Topical tacrolimus can be used as an effective, long-lasting therapeutic modality in treating LSC, especially in sensitive skin areas such as the face 3.
Comparison with Other Skin Conditions
- Lichen sclerosus (LS) is a different skin condition that can be effectively managed with topical triamcinolone ointment, resulting in significant reduction of patient symptom scores 4.
- Note that LSC and LS are distinct conditions with different treatment approaches.
Irrelevant Studies
- A study on the differences in the altered energy metabolism of hemorrhagic shock and hypoxemia is not relevant to the treatment of Lichen Simplex Chronicus 5.