| Treatment action | Topical/behavioral | Oral meds | Intramuscular meds | Intralesional meds | Testing/Notes |
|---|---|---|---|---|---|
| Comfort measures, general care | Sitz bath, gentle cleansing, topical petrolatum, avoidance of irritants or tight clothing, application of cool gel packs | Always do pH, wet prep, and yeast culture. Consider bacterial culture if superimposed infection is suspected. Biopsy if unsure of diagnosis. (LINK to biopsy)
Steroid medications can enhance development of infectious conditions such as candidiasis, herpes simplex, and condyloma. Consider obtaining North American Series patch testing to learn more about possible irritants. Link to Lichen Simplex Chronicus in Atlas |
|||
| Reduction of itching or pain | Topical xylocaine 5%, applied as needed, usually 4-6 times a day (no more than 15 grams a day) | Hydroxyzine 10 to 25 mg orally 1-2 hrs prior to bedtime; (may start at 10 mg and increase nightly to a maximum of 75 mg)
OR Benadryl 25-50 mg orally 1-2 hrs prior to bedtime, stopping meds as symptoms subdue. |
|||
| Anti-inflammatory action | 1% to 2.5% hydrocortisone or desonide 0.05% ointment applied once or twice daily for mild inflammation. This dose may be used once more potent steroids have improved the condition. Betamethasone 17-valerate 0.1% ointment applied twice a day in a thin film until improved x 1 monthOR
Triamcinolone acetonide 0.1% ointment applied twice a day in a thin film until improved x 1 month OR Clobetasol or halobetasol 0.05% ointment applied twice a day, in a thin film, tapering with improvement or reducing to one of the mid-low potency steroid ointments |
Prednisone or methylprednisolone 40-60 mg every morning for 5 days, or a tapering dose up to 7-10 days (for diffuse inflammation, or for those unresponsive to topical treatment) | Triamcinolone acetonide 40 mg/ml (Kenalog 40) 1 mg per kg intramuscularly, single dose for diffuse inflammation or for those unresponsive to topical treatment | Triamcinolone acetonide (Kenalog 10), 10 mg/mL diluted 1:1 with saline and using a 30-gauge needle; injected under plaque after application of EMLA (for large, thick areas or those unresponsive to topical treatment) | For injectable steroids, you must shake the bottle prior to dispensing and also shake the syringe prior to injecting. |
| Treatment for concomitant candidiasis | Fluconazole 150 mg orally every 72 hrs x 3, then weekly until symptoms are gone; for LSC, use in conjunction with steroid treatment. | ||||
| Antibiotics for superimposed infection | Dicloxacillin 250-500 mg orally 4 x a day for 10 days
OR Cephalexin 250-500 mg orally 4 x a day for 10 days |
||||
| Reduction of the habit of scratching | Counsel to bring importance of this to patient’s awareness. | SSRIs may be helpful; dosing should start low and slowly build; tapering off the medication should be done very slowly:Fluoxetine (Prozac) 10-20 mg orally, dailyOR Citalopram (Celexa) 10-20 mg orally daily OR Other SSRIs |
Updated 7/11/14 Link to Lichen Simplex Chronicus in Atlas