When is steroid injection recommended for lichen simplex chronicus?

Lichen simplex chronicus, also called neurodermatitis, is a scratch-thickened area created by an itch–scratch cycle. A local steroid injection delivers anti-inflammatory medicine into a selected thick plaque. It may be considered when the patch is particularly thick, persistent, or difficult to treat with a cream, and when the diagnosis fits the examination.

The injection does not remove the trigger by itself. Friction, sweating, dry skin, contact irritation, or an underlying itch can keep the cycle going. A clinician may therefore combine local treatment with a plan to protect the skin and reduce scratching.

Before treatment, mention allergies, skin infections, previous reactions to steroids, and all medicines or creams used on the patch. Afterward, avoid rubbing or picking the area and use the recommended moisturiser or topical medicine. Keep nails short if scratching happens during sleep. Report worsening pain, spreading redness, drainage, or a depressed or lighter patch at the injection site.

Book an assessment if an itchy thick patch is new, changing, bleeding, or not improving, because eczema, psoriasis, fungal infection, or another skin condition can look similar. Seek prompt care for warmth, swelling, pus, rapidly increasing pain, or fever. These features need assessment before another steroid treatment is considered.

Ask whether the patch is suitable for an injection, what may be maintaining the itch–scratch cycle, and how to protect the area afterward. Discuss the expected local effects, signs of infection or skin thinning, and what alternative treatment could be used if the patch returns.