From the Guidelines
Lichen simplex chronicus should be treated with potent topical corticosteroids, such as clobetasol 0.05% ointment, applied once daily for 4 weeks, then on alternate nights for 4 weeks, and finally twice weekly for 4 weeks, as this regimen has been shown to be effective in reducing inflammation and breaking the itch-scratch cycle 1.
Treatment Overview
The primary goal of treatment is to reduce inflammation, prevent further skin damage, and alleviate symptoms.
- Topical corticosteroids are the first-line treatment for lichen simplex chronicus.
- Clobetasol propionate 0.05% ointment is a recommended treatment option, applied according to the regimen outlined above.
- Soap substitutes and barrier preparations should also be used to help manage the condition and prevent further irritation.
Management and Prevention
To prevent relapse and manage the condition effectively, it is essential to:
- Use the topical corticosteroid as directed and taper off as instructed to prevent rebound.
- Apply moisturizers regularly to repair the skin barrier, with ceramide-containing products being particularly effective.
- Implement physical interventions, such as covering affected areas with cotton gloves or bandages, to prevent scratching and keep fingernails short.
- Address underlying conditions, such as anxiety, stress, or other skin disorders, which can contribute to the development and persistence of lichen simplex chronicus.
Persistent Cases
For cases that do not respond to first-line treatment, consider:
- Intralesional corticosteroid injections, such as triamcinolone 5-10mg/ml, for localized areas of hyperkeratosis.
- Systemic treatments, like oral corticosteroids, for short courses in severe cases.
- Referral to a specialist clinic for further management and consideration of alternative treatment options, as outlined in the British Association of Dermatologists guidelines 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
- Topical corticosteroids have the most robust evidence for treating LSC, with 7 RCTs supporting their use 2
- Other treatments with limited data suggesting benefit include:
- Topical immunomodulators
- Topical antipruritic agents
- Oral antihistamines
- Antiepileptics
- Antidepressants 2
- Novel treatment approaches include:
- Transcutaneous electrical nerve stimulation
- Focused ultrasound
- Phototherapy 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 Conditions
- Lichen simplex chronicus is distinct from other conditions such as lichen sclerosus, which can be managed with topical triamcinolone ointment 4
- Oral lichen planus has been studied in a randomized clinical trial, which found that the combination of oral acitretin and topical triamcinolone was more effective than topical triamcinolone monotherapy 5
- There is no relevant information on the treatment of LSC in studies related to hemorrhagic shock and hypoxemia 6