Treatment Overview

The defining characteristic of lichen simplex chronicus is an itch so intense that it becomes impossible to ignore. This condition, often described as “the itch that rashes,” creates a frustrating cycle where scratching leads to thickened, leathery skin, which in turn itches even more. This itch-scratch cycle can disrupt sleep, cause embarrassment due to the appearance of the skin, and lead to significant emotional distress. Breaking this cycle is the most important step in recovery, but it is often the hardest to achieve without medical support. 

Treatment is essential not only to relieve the nagging physical sensation but also to allow the thickened skin (lichenification) to heal and return to a normal texture. Because the condition is often triggered by stress, anxiety, or underlying eczema, the approach must be multifaceted. Successful management requires a combination of behavioral strategies to stop the scratching and pharmacological interventions to quiet the inflammation (National Eczema Association, 2021). 

Overview of treatment options for Lichen Simplex Chronicus 

The primary goal of treatment is to stop the itch immediately to prevent further trauma to the skin. Once the scratching stops, the skin can begin to heal itself. Treatment plans typically focus on softening the thickened plaques, reducing inflammation, and addressing the psychological or habitual components of the scratching. 

While moisturizers and covering the area (occlusive dressings) are vital lifestyle measures, medications are the engine that drives recovery. Treatment usually starts with potent topical applications to penetrate the thick skin barrier. In resistant cases, doctors may use injections or systemic medications to break the cycle. The timeline for recovery varies, often taking several weeks for the thickened skin to smooth out completely. 

Medications used for Lichen Simplex Chronicus 

Doctors rely on medications that can penetrate the toughened outer layer of the skin to deliver relief deep within the tissue. 

Topical corticosteroids: High-potency steroid creams or ointments are the first-line treatment for this condition. Medications such as clobetasol or betamethasone are frequently prescribed because weaker steroids often cannot penetrate the thickened plaques effectively. Clinical experience suggests that applying these ointments under a bandage or patch (occlusion) significantly increases absorption and speeds up the healing process. Patients can expect the itch to subside within a few days, but the skin texture takes longer to improve. 

Intralesional corticosteroids: For very thick or stubborn patches that do not respond to creams, a doctor may inject a steroid solution directly into the lesion. This delivers a concentrated dose of medication exactly where it is needed to flatten the plaque and stop the itching. 

Sedating antihistamines: Because much of the damage in lichen simplex chronicus happens during sleep, doctors often prescribe oral antihistamines like hydroxyzine or diphenhydramine. These are used less for their anti-itch properties and more for their sedative effects, helping patients sleep through the night without scratching unconsciously. 

Keratolytics: These agents help break down the thick, scaly skin. Preparations containing salicylic acid may be used in conjunction with steroids to thin the plaque, allowing the anti-inflammatory medication to penetrate more easily. 

How these medications work 

The medications used for lichen simplex chronicus target both the inflammation and the physical barrier of the skin. 

Topical corticosteroids penetrate skin cells to block inflammatory chemicals, constrict blood vessels, and suppress the immune response, rapidly reducing redness, heat, and itching. High-potency options are necessary to overcome the thickened, protective skin barrier. 

Sedating antihistamines block histamine receptors to reduce itching signals. Their drowsiness effect helps stop nighttime scratching, allowing the skin to heal undisturbed. Keratolytics loosen bonds between cells in the thickened outer layer, promoting shedding and softening of the excess skin. 

Side effects and safety considerations 

Potent medications require careful use to avoid adverse effects. 

Prolonged use of high-potency topical corticosteroids risks skin thinning, stretch marks, or discoloration; use should be brief or tapered under a doctor’s care, especially near eyes or on thin skin. 

Sedating antihistamines cause drowsiness, dry mouth, and dizziness; avoid driving or operating heavy machinery. 

A broken skin barrier from scratching risks secondary bacterial infection. Seek immediate medical attention if the area becomes warm, painful, or develops a honey-colored crust, as antibiotics may be necessary. 

Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care. 

References 

  1. National Eczema Association. https://nationaleczema.org 
  1. American Academy of Dermatology. https://www.aad.org 
  1. Mayo Clinic. https://www.mayoclinic.org 
  1. Cleveland Clinic. https://my.clevelandclinic.org 

Medications for Lichen Simplex Chronicus

These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Lichen Simplex Chronicus.

Found 3 Approved Drugs for Lichen Simplex Chronicus

Doxepin

Brand Names
Silenor, Zonalon, Prudoxin

Doxepin

Brand Names
Silenor, Zonalon, Prudoxin
Form: Cream, Tablet, Capsule, Solution
Method of administration: Oral, Topical
FDA approval date: May 13, 1986
Classification: Tricyclic Antidepressant
Doxepin Hydrochloride Capsules, USP are recommended for the treatment of: 1. Psychoneurotic patients with depression and/or anxiety. 2. Depression and/or anxiety associated with alcoholism (not to be taken concomitantly with alcohol). 3. Depression and/or anxiety associated with organic disease (the possibility of drug interaction should be considered if the patient is receiving other drugs concomitantly). 4. Psychotic depressive disorders with associated anxiety including involutional depression and manic-depressive disorders. The target symptoms of psychoneurosis that respond particularly well to doxepin hydrochloride capsules include anxiety, tension, depression, somatic symptoms and concerns, sleep disturbances, guilt, lack of energy, fear, apprehension and worry. Clinical experience has shown that doxepin hydrochloride capsules is safe and well tolerated even in the elderly patient. Owing to lack of clinical experience in the pediatric population, doxepin is not recommended for use in children under 12 years of age.

MethylPREDNISolone Acetate

Brand Names
Medroloan, Medroloan SUIK, Depo-Medrol, Dyural

MethylPREDNISolone Acetate

Brand Names
Medroloan, Medroloan SUIK, Depo-Medrol, Dyural
Form: Injection, Kit
Method of administration: Intra-articular, Intramuscular, Intrasynovial, Intralesional, Soft Tissue, Infiltration, Topical, Intrameningeal, Intra-arterial
FDA approval date: May 28, 1959
Classification: Corticosteroid
A. FOR INTRAMUSCULAR ADMINISTRATION When oral therapy is not feasible and the strength, dosage form, and route of administration of the drug reasonably lend the preparation to the treatment of the condition, the intramuscular use of Methylprednisolone Acetate Injectable Suspension is indicated as follows: A llergic States : Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, serum sickness, transfusion reactions. De rmatologic Diseases : Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, pemphigus, severe erythema multiforme (Stevens-Johnson syndrome). E ndocrine Disorders : Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy, mineralocorticoid supplementation is of particular importance), congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis. G astrointestinal Diseases : To tide the patient over a critical period of the disease in regional enteritis (systemic therapy) and ulcerative colitis. Hem atologic Disorders : Acquired (autoimmune) hemolytic anemia, congenital (erythroid) hypoplastic anemia (Diamond Blackfan anemia), pure red cell aplasia, select cases of secondary thrombocytopenia. M iscellaneous : Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used concurrently with appropriate antituberculous chemotherapy. Neoplastic Diseases : For palliative management of leukemias and lymphomas. Nervous System : Cerebral edema associated with primary or metastatic brain tumor or craniotomy. O phthalmic Diseases : Sympathetic ophthalmia, temporal arteritis, uveitis and ocular inflammatory conditions unresponsive to topical corticosteroids. Re nal Diseases : To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome, or that due to lupus erythematosus. Re spiratory Diseases : Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis. R heumatic Disorders : As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy). For the treatment of dermatomyositis, polymyositis, and systemic lupus erythematosus. B. FOR INTRA-ARTICULAR OR SOFT TISSUE ADMINISTRATION (See WARNINGS) Methylprednisolone Acetate Injectable Suspension is indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis. C. FOR INTRALESIONAL ADMINISTRATION Methylprednisolone Acetate Injectable Suspension is indicated for intralesional use in alopecia areata, discoid lupus erythematosus, keloids, localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare, lichen planus, lichen simplex chronicus (neurodermatitis), and psoriatic plaques, necrobiosis lipoidica diabeticorum. Methylprednisolone Acetate Injectable Suspension also may be useful in cystic tumors of an aponeurosis or tendon (ganglia).

Betamethasone Acetate

Brand Names
Betaloan SUIK, Celestone Soluspan, BL-C, Betalido

Betamethasone Acetate

Brand Names
Betaloan SUIK, Celestone Soluspan, BL-C, Betalido
Form: Injection, Kit
Method of administration: Intra-articular, Perineural, Infiltration, Topical, Intramuscular, Intralesional, Soft Tissue, Intravascular
FDA approval date: April 28, 2010
Classification: Corticosteroid
For use as an first aid antiseptic pre-operative skin preperation. When oral therapy is not feasible, the intramuscular use of Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension is indicated as follows: Allergic States Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, serum sickness, transfusion reactions. Dermatologic Diseases Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides, pemphigus, severe erythema multiforme (Stevens-Johnson syndrome). Endocrine Disorders Congenital adrenal hyperplasia, hypercalcemia associated with cancer, nonsuppurative thyroiditis. Hydrocortisone or cortisone is the drug of choice in primary or secondary adrenocortical insufficiency. Synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy mineralocorticoid supplementation is of particular importance. Gastrointestinal Diseases To tide the patient over a critical period of the disease in regional enteritis and ulcerative colitis. Hematologic Disorders Acquired (autoimmune) hemolytic anemia, Diamond-Blackfan anemia, pure red cell aplasia, selected cases of secondary thrombocytopenia. Miscellaneous Trichinosis with neurologic or myocardial involvement, tuberculous meningitis with subarachnoid block or impending block when used with appropriate antituberculous chemotherapy. Neoplastic Diseases For palliative management of leukemias and lymphomas. Nervous System Acute exacerbations of multiple sclerosis; cerebral edema associated with primary or metastatic brain tumor or craniotomy. Ophthalmic Diseases Sympathetic ophthalmia, temporal arteritis, uveitis and ocular inflammatory conditions unresponsive to topical corticosteroids. Renal Diseases To induce diuresis or remission of proteinuria in idiopathic nephrotic syndrome or that due to lupus erythematosus. Respiratory Diseases Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis. Rheumatic Disorders As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis; acute rheumatic carditis; ankylosing spondylitis; psoriatic arthritis; rheumatoid arthritis, including juvenile rheumatoid arthritis (selected cases may require low-dose maintenance therapy). For the treatment of dermatomyositis, polymyositis, and systemic lupus erythematosus. The intra-articular or soft tissue administration of Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension is indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis. The intralesional administration of Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension is indicated for alopecia areata; discoid lupus erythematosus; keloids; localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare, lichen planus, lichen simplex chronicus (neurodermatitis), and psoriatic plaques; necrobiosis lipoidica diabeticorum. Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension may also be useful in cystic tumors of an aponeurosis or tendon (ganglia). Iodixanol injection is indicated in for: Iodixanol injection is a radiographic contrast agent indicated for the following: Intra-arterial Procedures. Lidocaine hydrochloride injection is indicated for production of local or regional anesthesia by infiltration techniques such as percutaneous injection and intravenous regional anesthesia by peripheral nerve block techniques such as brachial plexus and intercostal and by central neural techniques such as lumbar and caudal epidural blocks, when the accepted procedures for these techniques as described in standard textbooks are observed. For first aid to decrease germs in minor cuts scrapes burns For preparation of the skin prior to injection.
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