Lichenified perianal area

Lichenified (or thickened) skin occurs in response to chronic rubbing or scratching. Patients may experience more soreness than itch because of fissures, scratching or erosion. If the perianal area is lichenified, use a potent topical corticosteroid, followed by a less potent topical corticosteroid. Use:

betamethasone dipropionate 0.05% ointment topically, once daily until skin is clear and itch has resolved (may take up to 4 weeks) betamethasone dipropionate betamethasone dipropionate betamethasone dipropionate

FOLLOWED BY

methylprednisolone aceponate (adult, or child 4 months or older) 0.1% fatty ointment topically, once daily for 4 weeks, to prevent recurrence. methylprednisolone aceponate methylprednisolone aceponate methylprednisolone aceponate

When the soreness and itch have resolved, use a greasy emollient (eg white soft paraffin) as a barrier indefinitely.

If the condition recurs, repeat treatment with topical methylprednisolone aceponate 0.1% fatty ointment until symptoms resolve.