What is the treatment of choice for lichen simplex chronicus?

Updated: Feb 15, 2019
  • Author: Jason Schoenfeld, MD; Chief Editor: William D James, MD  more...
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Topical steroids are the current treatment of choice because they decrease inflammation and itch while concurrently softening the hyperkeratosis. [23, 24, 25] Because lesions are by nature chronic, treatment most likely is lifelong. On larger and more active lesions, a midpotency steroid may be used to treat acute inflammation. Occasionally, occlusion is used to increase potency and enhance delivery of the agent. Occlusion also provides a physical barrier to the scratching. Midpotency topical steroids are not recommended for thin skin (eg, vulva, scrotum, axilla, face). Direct long-term therapy more at daily use of low-potency nontrophogenic topical corticosteroids. High-potency topical corticosteroids may be used for 3-week courses on thicker-skinned areas.

Intralesional injection of corticosteroids is useful for refractory lesions. A 2018 report describes the use of a transcutaneous pneumatic injection device for lesions refractory to 1 month of treatment with a potent topical steroid. Triamcinolone injected into the lesions at 2-cm intervals led to significant improvement. [26]

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