From the Research
Lichen simplex chronicus should be treated with high-potency topical corticosteroids, such as clobetasol propionate 0.05%, applied twice daily for 2-4 weeks to reduce inflammation and itching, as this approach has the most robust evidence supporting its effectiveness 1.
Treatment Approach
The treatment of lichen simplex chronicus involves a multifaceted approach that includes:
- Breaking the itch-scratch cycle, which is crucial for managing the condition
- Applying moisturizers regularly and using wet wraps to improve skin barrier function
- Identifying and addressing triggers like stress, irritants, or allergens for long-term management
- Considering additional treatments, such as topical calcineurin inhibitors (tacrolimus 0.1%), phototherapy, or oral medications like doxepin or gabapentin, in severe cases
Pathophysiology and Clinical Characteristics
Lichen simplex chronicus is a form of chronic localized pruritus with a secondary dermatitis, characterized by thickened, leathery patches of skin resulting from persistent scratching or rubbing 2. The condition develops because repeated scratching triggers skin thickening (lichenification) as a protective response, which unfortunately creates more itching, perpetuating the cycle.
Current Therapeutic Options
Recent advancements in the understanding of lichen simplex chronicus and the itch-scratch cycle have enabled a substantial increase in treatment options 2. Topical corticosteroids, such as clobetasol propionate, remain a first-line treatment for reducing inflammation and itching 1, 3. Intralesional steroid injections (triamcinolone acetonide 5-10 mg/ml) may be necessary for stubborn cases. Antihistamines, such as hydroxyzine (25-50mg at bedtime), can help control nighttime itching.