Consider both pharmacological and non-pharmacological approaches to managing pruritus in lichen simplex chronicus

Lichen simplex chronicus (LSC) is a pruritic dermatosis where an itching sensation (be it from psychological, environmental, dermatological or systemic origin) triggers a persistent itch-scratch cycle, leading to skin barrier disruption, lichenification and chronic inflammation. This results in a characteristic lichenified plaque. LSC is associated with reduced quality of life and psychiatric comorbidities, such as depression and anxiety, which can further exacerbate the disease. The first-line treatment is topical corticosteroids, though other topical treatments (e.g. calcineurin inhibitors, topical analgesics) are available when these are ineffective. Systemic treatments, such as antidepressants, may be considered, though non-pharmacological, procedural therapies, such as carbon dioxide laser therapy or focused ultrasound have recently shown promise in the treatment of LSC-associated pruritus.