Clobetasol cream

Thanks..I used it as prescribed and my LS went away very quickly, but I have been lax and have not used it at all after the first treatment, I guess I was busy with other problems, I had just been diagnosed with ulcerative colitis at the time, and then I read reacently that you need to apply the cream at least weekly for maintenance, so my question is should I just use this strong cream twice a week or once a week as Merrill suggested.  Also I have recently got a slight sore near my anus, and what feels like a paper cut in the crack of my butt, I am guessing this is all LS related?

Thanks

Guppy, that does sound like LS. I always get a crack in my perineum, starting at the vagina and it used to sometimes go all the way to my anus. Do continue the clob twice a week. It needs to be strong because LS skin is extremely thick. Don't be fooled by the way it turns white and splits. This doesn't mean your skin is thin. It splits because the white skin is just dead cells. I find now that I'm on clob maintenance the crack of a slight flare doesn't go very deep (the clob is keeping the white layer from getting thick) so it heals quickly with an extra day of clob.

Hi Morrell, 

I know I have LS but my original post was just me wondering what the heck the difference was between the two.

Anyway, I have a question please.

When I was first diagnosed and applied the cream to the white effected skin, it was inside my vagina, in my inner lips, and they cleared up quickly within the week..So my question is this...I have no white areas at all, everything looks good, apart from the little sore I mentioned, but where do I apply the cream everywhere? inside and outside? even if there is no white areas?  I am annoyed with myself that I didnt really continue on with the treatment, but luckily everything looks ok.  I wondered do you take spritz baths twice a week before applying the cream.

Thank you

I just soak in the tub. The little sore is active LS. Just keep the tiny bit of clob on the areas that used to be affected. My gynae told me to limit the application to the thin line down my bum crack, since the large area wasn't red or sore. So, that's a reduction of the area of application. I don't think I'll ever stop using it on my perineum, which is the worst. And the very front where it tends to be more or less red and bumpy where there's a lot of hair. Some gynaes actually show patients where to apply it. You might need to see what they say. Anyway, glad you're feeling confident in the meds. We don't need any worries, do we?

Thank you, thats been very helpfull.  I realised today I have eaten a lot of chololate recently, a friend brought me some back from the UK and after reading up on LS is seems that is a strong trigger!..

Good call, Guppy. A year ago I got in the habit of buying these huge bars of supposedly 'French' milk chocolate for $4 each. We were eating way too much night after night. This was the period when I developed the pseudocystic smegmatic abscess Dr. Goldstein mentions early in his presentation. Here's that disussion:

https://patient.info/forums/discuss/pseudocystic-smegma-abcess-295940

That is probably because of the high oxalate content in the chocolate. Apparently it has something to do with gut flora being out of whack.

Maybe. But for me I think it just happened to be the food I was getting the biggest doses of sugar from. Ice cream and cheesecake do the same thing.

hi morrell

is clob the same as dermovate? its all so confusing!!!

Dermovate is a brand name for clobetasol propionate .05%. I was prescriber generic clobetasol cream in August 2013. I used up the tube and then found out on Dr. Goldstein's talk that the ointment penetrates the thick lichen sclerosus skin better, and that Dermovate brand is better than the generic version. When I renewed I asked the pharmacist to give me Dermovate brand clobetasol ointment.

Jackie, I know how confusing it all is at first, but we're pretty much all prescribed one of a handful of the 'ultra-potent' topical steroids. If you Google 'topical steroid potency' you'll get a chart where the over-the counter corticosteroid cream is at the bottom and our prescription is at the top.

At the risk of repeating what's appeared several times before, here's the full deal:

Dr. Andrew Goldstein has 1200 patients with lichen sclerosus, the most in the world. His wife is a dermatologist. He attends all her meetings that cover the vulva.

https://patient.info/forums/discuss/dr-goldstein-lecture-271556

He says forcefully that it takes this 'ultra-potent' steroid (8000 times more potent than hydrocortisone) to treat the incredible amount of inflammation way down deep in the 'basement' layer of this extremely thickened skin. Thinning is actually part of the treatment strategy. LS skin is not thin but extra thick, because it's all scar tissue and hardly any skin cells. The white blood cells that cause inflammation are way down deep at the bottom of this thick tissue.

1. Soak in warm water for twenty minutes first to soften the tissue

2. Rub, rub, rub, the prescribed cream/ointment in for about 90 seconds.

Stop worrying about thinning the skin. It's way too thick! That's one of the treatment strategies of clobetasol. We want the skin to get thinner.

Use the ointment, not the cream, because the cream tends to stay near the top and not penetrate.

Quite a few women find the base of generic Clobetasol irritates. Brand-name (Dermovate) costs double, but it's enough for a whole year. 20-minute warm pre-soaks soften the keratinized skin to help the meds penetrate deeply.

Best advice: don't wash down there with soap. Plain water is all you need.

Don't wear tight pants and wear cotton panties.

Just recently we've learned from our member who's a doctor:

"There was correspondence in the British Journal of Dermatology recently regarding the cause of LS, and Dr. Chris Bunker from University College Hospital in London, who is a dermatologist seemingly interested in male genital dermatology. He suggests that it is likely that LS may be due to "chronic occluded exposure of susceptible  epithelium to urine". This means  urine on sensitive areas may be affecting the tissues and causing inflammation which leads in the longer term to the sclerosis, which then causes either itching , soreness and lack of the normal elasticity which leads to tearing.  The reason for this suggestion is that males circumcised at birth never get LS,males never get it around the anus, LS appears around surgical scars and genital piercings, and also around urostomies (where the urine tubes are brought out on the skin after bladder removal). Circumcision also seems to cure males with the condition.  It is suggested that some genetic predisposition of the skin "barrier" , such as occurs in eczema, allows it to occur in some women and not others. This genetic predisposition may explain the connection with autoimmune diseases. "

So, applying vaseline before urination seems like a good practice.

 

thanks Morrell that all makes sense.  i can go for ages with nothing and then wham!!!!