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DERMATOLOGY PEARLS
Year : 2020  |  Volume : 11  |  Issue : 4  |  Page : 660-661  

A simple and effective therapeutic approach to lichen simplex chronicus


Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication13-Jul-2020

Correspondence Address:
Binod K Khaitan
Room 4067, Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_258_19

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How to cite this article:
Khaitan BK, Gupta S. A simple and effective therapeutic approach to lichen simplex chronicus. Indian Dermatol Online J 2020;11:660-1

How to cite this URL:
Khaitan BK, Gupta S. A simple and effective therapeutic approach to lichen simplex chronicus. Indian Dermatol Online J [serial online] 2020 [cited 2020 Aug 6];11:660-1. Available from: http://www.idoj.in/text.asp?2020/11/4/660/289611




   Problem Faced Top


Lichen simplex chronicus (LSC), is a commonly encountered difficult-to-manage condition that affects the quality of life of patients.[1] It tends to follow a chronic course, sometimes in years or even decades, unless the itch–scratch cycle is broken. If not treated till it flattens completely and clears, except some residual pigmentary changes, recurrences are frequent. The standard prescription consists of topical corticosteroids applied once or twice daily, emollients and antihistamines.[2] The response takes a long time and is generally partial. This leads to frustration. Topical corticosteroid under occlusion is used by many as a modality for management LSC.[3] Occlusion does provide a physical barrier to scratching and permits enhanced and prolonged application of topical medications. However, it is almost impractical if it has to be used for more than a few days. Also, depending on the site it may be difficult to achieve and sometimes socially unacceptable. Moreover, prolonged occlusion can also produce atrophy and depigmentation of immediate surrounding skin.


   Solution Proposed Top


We propose a simple, effective, and practical therapeutic approach, wherein the patient is advised to apply high potency topical corticosteroids (e.g., Clobetasol propionate, preferably in ointment base), 'as-and-when' he intends to itch. The frequent application of topical corticosteroids acts by two ways. First, the anti-inflammatory action of corticosteroids inhibits cytokine activation and release of mediators of pruritus. Second, it modifies the “itch sensation”, thereby interrupting the vicious itch-scratch cycle. This results in rapid relief of symptoms and faster resolution of lesions.

The crux of achieving successful outcome is “frequent” application, i.e., whenever there is an urge to itch. We observed that the frequency of application varied from four to six times for initial few days, followed by decreased frequency to once or twice a day, with significant improvement in itching and flattening of lesion over 2-3 weeks [Figure 1]. Once the lesions improve, use of lower potency topical corticosteroid and subsequently bland emollients are enough. This 'step-down approach' helps in restoring the epidermal barrier and prevents recurrence. Despite frequent application of topical corticosteroid at the onset of therapy, the total cumulative dose is reduced, thereby minimizing the adverse effects. Moreover, application of topical corticosteroids on 'as and when required basis' improves patient compliance and motivates for habit reversal. This approach gives a sense of subjective freedom to the patient, which helps to improve the outcome.
Figure 1: (a) Lichen simplex over right medial malleolus for 20 years in a 44-year-old male, (b) significant improvement in the lesion two weeks after treatment, (c) complete flattening of lesion with residual pigmentary changes at 4 weeks

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
An JG, Liu YT, Xiao SX, Wang JM, Geng SM, Dong YY. Quality of life of patients with neurodermatitis. Int J Med Sci 2013;10:593-8.  Back to cited text no. 1
    
2.
Ingram JR. Eczematous disorders. In: Griffiths CEM, Barker JNWN, Bleiker T, Chalmers RJG, Creamer D, editors. Rook's Textbook of Dermatology. Oxford. 9th ed. West Sussex: WILEY Blackwell; 2016. p. 39.28-30  Back to cited text no. 2
    
3.
Bard JW. Flurandrenolone tape in the treatment of lichen simplex chronicus. J Ky Med Assoc 1969;67:668-70.  Back to cited text no. 3
    


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