Lichen Simplex Chronicus
Lichen Simplex Chronicus (LSC) skin condition caused by chronic scratching. It can occur anywhere on the body.
WHAT CAUSES IT?
The itch may have started because of another skin condition (eg. eczema), an infection or an allergic reaction. As a result of chronic scratching the nerve endings in the skin become sensitized and itch even more creating an ‘itch-scratch-itch cycle’. Cracks in the skin may become infected with yeast and or bacteria.
WHAT ARE THE SYMPTOMS?
A strong urge to scratch the skin! You may wake up at night scratching. You may notice that some things increase your itch - heat, sweat, stress, tight clothing, and menstruation. The skin may look pink, dusky red, or even purple. There may be swelling and thickening of the skin so that it feels leathery. You may see raw, wounded skin or abrasions from scratching.
HOW DO YOU DIAGNOSE THIS CONDITION?
LSC is diagnosed based on a detailed history, and examination of vulvar skin changes. Sometimes a small sample of skin (biopsy) will be taken to assist diagnosis.
HOW DO YOU TREAT THIS CONDITION? The goal of treatment is to stop the “itch-scratch-itch cycle”.
• Be gentle with the vulvar skin. Avoid irritants. Do not over-wash the skin.
• Moisturize and protect the skin. Choose a good emollient and or barrier cream.
• Stop scratching the skin. Cold compresses or sitz baths can provide relief. Antihistamines or sedatives to relieve night time itching may be helpful. Some antidepressants have strong anti-itch properties and may help you sleep.
• Topical medium to high potency steroids will reduce the inflammation, diminish the itch and heal the skin
HOW MUCH STEROID TO USE?
We recommend patients use .- 1 Fingertip Unit (FTU) per application; 1 FTU is the amount of ointment expressed from a tube with a 5 mm nozzle, applied from the distal skin crease of the index finger to the tip (approximately 0.5 g) and is enough medication to cover the vulva. A 30-g jar will last you at three months. This amount of steroid is safe even if you are pregnant.
WHAT ARE THE GOALS OF THERAPY?
The goals of therapy are; (1) improve your daily symptoms so that you can STOP scratching the skin.
HOW LONG DO I NEED TO USE THIS MEDICATION?
Improvement will take week to months. Itching may flare from time to time. As the skin improves, the steroid can be applied less frequently. Once the skin has healed you should be able to stop the medication.
WHO DO I SEE FOR FOLLOW UP?
Normally you should see a doctor after your first 6-8 weeks of therapy. If you are still having symptoms, please discuss with your doctor at the follow up appointment.
