Treatment: Therapy is often directed at breaking the itch-scratch cycle. This is attempted with a combination of topical high-potency corticosteroids and oral antihistamines or gabapentin. The sedating antihistamines work better than the newer, nonsedating ones. Topical steroids may be used under occlusion for better penetration of the lichenified region. Intralesional injection with triamcinolone may be attempted. Capsaicin, which is derived from capsicum peppers, may be used. This agent works by depleting the superficial nerve endings of substance P, the neurotransmitter required for the itching sensation. Patients should be advised to trim their fingernails to help prevent trauma when they scratch. Behavioral modification may be attempted, but it is best accomplished by a professional psychiatrist or psychologist. Precipitating causes such as stress should be addressed. Patients often have remissions with frequent relapses.
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