What is the first treatment for lichen simplex chronicus?

Lichen simplex chronicus, also called neurodermatitis, forms when repeated rubbing or scratching makes a patch of skin thicker, rougher and more intensely itchy. Common sites include the neck, ankles, wrists, lower legs and genital skin, although it can occur elsewhere. The itch and the scratching reinforce one another.

A topical corticosteroid reduces inflammation in the thickened patch, making the itch easier to control. It works best alongside measures that reduce access to the area or replace scratching with a gentler action. An injection into the skin may be considered for a stubborn, localised plaque.

Apply the prescribed topical corticosteroid exactly as directed, moisturise regularly and keep fingernails short. A cool compress, loose clothing or a covering at night may reduce rubbing. Avoid fragranced products, hot water and vigorous scrubbing over the patch.

Look for triggers such as eczema, an insect bite, contact irritation, stress or friction, because treating the trigger can prevent the thickening from returning. If the patch remains active despite appropriate topical care, ask whether a steroid injection into the skin is suitable.

Arrange a review if the area bleeds, becomes painful, develops pus, spreads, or does not improve with the prescribed plan. Seek earlier advice for a genital patch, a changing solitary lesion or severe itch that disrupts sleep.

Ask what may have started the itch, how long to use the topical corticosteroid, whether a covering is appropriate, and when an injection or another diagnosis should be considered.