Emerging treatments

Botulinum toxin

Isolated treatment with intradermal injection of botulinum toxin type A into circumscribed areas of LSC resulted in resolution of pruritus within 3 to 7 days and clearing of these LSC lesions within 2 to 4 weeks in one small study (5 lesions in 3 patients).[52] The mechanism behind this effect is hypothesised to be secondary to the blockade of acetylcholine, a mediator of pruritus in atopic dermatitis. Another study found that botulinum toxin injection significantly reduced the Eczema Area and Severity Index (EASI) score in patients with LSC, but 4/12 patients experienced recurrence after 3 months.[53]

Acupuncture and electroacupuncture

Acupuncture and electroacupuncture (low-voltage, high-frequency electrical stimulation applied to acupuncture needles) have been used to treat LSC and may act by reducing proinflammatory neuropeptides in inflamed skin. One meta-analysis reported that acupuncture resulted in improved effectiveness and reduced recurrence compared with a control of conventional drug treatment; however, the level of evidence was limited by the small number of studies, small sample sizes, and uncertain risk of bias.[54]

Gabapentin

Treatment with gabapentin for 4 to 10 months led to total or partial remission of LSC in one case report.[55]

Topical aspirin or salicylic acid

One randomised trial of 29 patients with LSC found a significant therapeutic response in 46% of patients treated with topical aspirin versus 12% who received placebo.[56]​ Topical corticosteroids combined with keratolytics like salicylic acid may also be effective for LSC.[6]

Topical ketamine plus lidocaine plus amitriptyline

An analgesic mixture thought to relieve pruritus by reducing hypersensitivity of peripheral nerve fibers.[6][57]​ One retrospective study reported it was effective for patients with chronic pruritus, including some patients with LSC.[57]​

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