|Year : 2020 | Volume
| Issue : 4 | Page : 660-661
A simple and effective therapeutic approach to lichen simplex chronicus
Binod K Khaitan, Savera Gupta
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||13-Jul-2020|
Binod K Khaitan
Room 4067, Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
|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 2021 May 11];11:660-1. Available from: https://www.idoj.in/text.asp?2020/11/4/660/289611
| Problem Faced|| |
Lichen simplex chronicus (LSC), is a commonly encountered difficult-to-manage condition that affects the quality of life of patients. 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. 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. 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|| |
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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Conflicts of interest
There are no conflicts of interest.
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