This protocol is for patients with lichen simplex chronicus whose pruritus and skin inflammation have not been adequately controlled with first-line topical management, and in whom a structured next treatment step is now indicated.
First-line treatment centres on topical corticosteroids applied to affected plaques, together with adjunctive topical agents and behavioural strategies including trigger avoidance and habit-reversal therapy. When a follow-up assessment around week 3 shows that the primary targets — reduction of pruritus and inflammation of the affected skin — have not been reached, this approach is considered inadequate and a further treatment step is indicated.
Once topical treatment proves insufficient, the focus shifts to systemic agents that target different mechanisms of the itch–scratch cycle — including neuropathic pruritus, nocturnal itching, and compulsive scratching behaviour. The clinical goal remains reduction of pruritus and scratching behaviour. The complete structured regimen specifies which agents are involved and in what context.
DOI: 10.1007/s40257-025-00979-z
When topical treatments prove inadequate, systemic agents may be considered for LSC management.
Gabapentin and pregabalin are prescribed for their efficacy in reducing neuropathic pruritus, though dizziness is a common side effect patients experience.
Antidepressants, particularly sedating tricyclics such as doxepin, are frequently used to alleviate nocturnal itching and may also be beneficial in patients with coexisting depression or anxiety.
Selective serotonin reuptake inhibitors (SSRIs) may reduce compulsive scratching behaviors in patients with underlying obsessive traits or persistent daytime symptoms.
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