Fractional Carbon Dioxide Laser for Lichen Simplex Chronicus: A Randomized Controlled Trial

BACKGROUND Lichen simplex chronicus (LSC) is a common itchy dermatosis. Topical steroids are usually used as first-line therapy. Fractional carbon dioxide (CO 2 ) laser has shown efficacy in reduction of pruritus in different itchy dermatoses. However, controlled studies evaluating its efficacy in LSC are scarce in the literature. OBJECTIVE The authors aimed to compare the efficacy of fractional CO 2 laser either alone or combined with topical corticosteroid to topical corticosteroid alone in treatment of LSC. PATIENTS AND METHODS Sixty LSC patients were randomized into 3 groups receiving fractional CO 2 laser, topical corticosteroid, or both, for 3 months. Disease severity was assessed before and after treatment, using patient-reported outcomes, namely pruritus severity scale and visual analog scale (VAS), and physician-reported outcomes in the form of erythema, lichenification, scaling and excoriation scores and Investigator's Global Assessment (IGA). RESULTS Treatment with combined fractional CO 2 laser and topical corticosteroid was associated with the highest incidence of achieving IGA score of 0 or 1 and VAS 50%, followed by laser and then topical corticosteroid arms (93.3%, 66.7%, and 50%, p = .016 and 100%, 86.7%, and 66.7%, p = .028, respectively). CONCLUSION Fractional CO 2 laser is an effective tool for treatment of LSC. Combination with topical corticosteroids can improve the outcome.