Recalcitrant Lichen Simplex Chronicus Successfully Treated With Fractional Laser-Assisted Topical Corticosteroid Delivery

We report 2 lichen simplex chronicus (LSC) cases of several years’ history that were successfully treated with an ablative fractional 10,600-nm carbon dioxide laser (AFXL) and a topical corticosteroid. After years of topical and oral treatments with minimal improvement, the pruritus was relieved after a single session of AFXL with potent topical steroid application. This treatment could be considered as an option for LSC when it does not respond to other classical treatments. Informed consent was obtained from each patient. The study conformed to the ethical guidelines of the 1975 Declaration of Helsinki. Case 1 is a 41-year-old woman (Fitzpatrick skin type II) with more than a 5-year history of LSC on both insteps of her feet (Figure 1) confirmed by a cutaneous biopsy. An anesthetic cream was applied 1 hour before the treatment. We treated the patient with a 10600 nm AFXL (Youlaser MT, Quanta System) as follows: 20 W, 1.5 m s, stack 2, 9% density, and 60 mJ/dot. A betamethasone 0.5 mg/g cream was applied immediately. Case 2 is a 58-year-old woman (Fitzpatrick skin type III) with a 15-year history of a unique plaque of LSC on her right thigh (Figure 2) confirmed by a skin biopsy. She was treated with the AFXL as follows: 25w, 1.5 m s stack 2, 13% density, and 75 mJ/ dot. A clobetasol propionate 0.5 mg/g cream was applied immediately and under occlusion for 2 hours. After laser treatment, a 0.05% betamethasone cream was prescribed twice a day for 15 days for both patients. After that, they only used topical emollients. Before the treatment, the pruritus was very intense in both cases and caused anxiety and itching at night. Both patients received several treatments through the years, including potent corticosteroids with occlusive cures, tacrolimus, several emollient ointments, and oral antihistamines, with minimal improvement. At that time, neither patient was taking any medication. The patients reported decreased pruritus in the first days after the treatment. Slight crusting for 7 to 10 days was reported. However, no pain or other secondary effects were described. Both of them reported a great amelioration after 1 month. After an 8-week follow-up postbaseline, case 1 showed complete resolution of the lesions (Figure 3) and case 2