Patient discussions
Patient education and encouragement to stop scratching, in conjunction with other therapies, is extremely important to help break the itch-scratch cycle characteristic of LSC. Techniques include reinforcing the importance of resisting the urge to scratch, clenching of the fists for 30 seconds followed by pinching of the pruritic site in lieu of scratching, and applying crushed ice to areas of pruritus.[17][58]
Once the acute lesion has been brought under control, advise patients to contact their physician and resume treatment in the event of recurrence.
Maintaining an intact epidermal barrier is extremely important in the prevention of LSC. Recommend appropriate gentle cleansing, avoiding irritants and exacerbating factors, and moisturizing with a bland, unperfumed cream or ointment emollient while the skin is still wet immediately after showering.[7][22] Emollients should be used at least twice a day and more frequently if the patient is able.[2] Patients with vulvar LSC should use adequate lubrication for intercourse.[22]
Explain of the appropriate use of topical corticosteroids and give instructions on the proper use of occlusion. When a potent topical corticosteroid is prescribed, the product should be marked with the patient instruction "not to be used for longer than 2 to 3 weeks at a time".[2]
Patients should be shown how to slowly titrate up the dose of nighttime sedating agents such as hydroxyzine or doxepin until nighttime pruritus has resolved. These medications should be taken 2 hours before bed to avoid a morning "hangover" with sedation, a dry mouth, and blurred vision.[2]
British Association of Dermatologists: Lichen simplex Opens in new window
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