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Worried about side effects of corticosteroid cream/ointment

Posted , 5 users are following.

Morrell1951
Morrell1951

I was looking up Halobetasol to make sure it's the same as Clobetasol and Dermovate. Apperently it is. I read somewhere else that LS sufferers use between 30 and 60 grams PER YEAR on our vulva. That's true for me. A 50 g. tube has lasted a year.

This was the paragraph about side effects of Halobetasol, my emphasis.

"General: Systemic absorption of topical corticosteroids can produce reversible hypothalamic-pituitary-adrenal (HPA) axis suppression with the potential for glucocorticosteroid insufficiency after withdrawal of treatment. Manifestations of Cushing's syndrome, hyperglycemia, and glucosuria can also be produced in some patients by systemic absorption of topical corticosteroids while on treatment. Patients applying a topical steroid to a large surface area or to areas under occlusion [like wrapped in plastic] should be evaluated periodically for evidence of HPA axis suppression. This may be done by using the ACTH stimulation, A.M. plasma cortisol, and urinary free-cortisol tests. Patients receiving super potent corticosteroids should not be treated for more than 2 weeks at a time and only small areas should be treated at any one time due to the increased risk of HPA suppression. Halobetasol propionate cream produced HPA axis suppression when used in divided doses at 7 grams per day for one week in patients with psoriasis. These effects were reversible upon discontinuation of treatment. If HPA axis suppression is noted, an attempt should be made to withdraw the drug, to reduce the frequency of application, or to substitute a less potent corticosteroid. Recovery of HPA axis function is generally prompt upon discontinuation of topical corticosteroids. Infrequently, signs and symptoms of glucocorticosteroid insufficiency may occur requiring supplemental systemic corticosteroids. For information on systemic supplementation, see prescribing information for those products."

If you want to see the worst case scenario of psoriasis, watch the film, 'The Singing Detective', written by a similar psoriasis patient. These people have horrible scales over most or all of their bodies and therefore get high doses of this cream. I've used probably pounds of milder corticosteroids on my skin over a period of thirty years, before I quit and suffered a terrible flare from withdrawal. We LS sufferers are using a tiny pea-size blob twice a week, except at the beginning and during bad flares, on a few square inches of skin.

Just to put our minds at rest. Everything is relative.

1 like, 10 replies

10 Replies

  • kathleen65757
    kathleen65757 Morrell1951

    Posted

    I was changed to Advantan fatty ointment quite a few years back and it seems to work very well. Sometimes I forget to use the cream then think I had better use it. I am supposed to use either second or third night but it settles without symptoms and that is when I forget to use it. I can have a flare especially if something else is going on like a Crohns flare. Thanks for above information. I can always feel the unsmooth skin so I know the recommendation from my specialists are correct. 
    • Morrell1951
      Morrell1951 kathleen65757

      Posted

      Kathleen, when you've mentioned Advantan fatty ointment before I didn't realize it was yet another corticosteroid. So that's four I've seen mentioned in this forum now. You're right, we need to keep using it every third night or so as maintenance. I find I can remember having only put my oily creams on for two previous nights, so it's time to use the clobetasol again. I use it an extra night if I'm very red at the back or there's a new tear. Or for itching at the front. Such a tiny dab, though.
    • kathleen65757
      kathleen65757 Morrell1951

      Posted

      I have never had a tear. I think the Advantan fatty ointment is not as bad as some? Not sure though! I can get itchy if I forget to put it on for too long and I can feel rough skin but no tear! I go to a top women's hospital to a special clinic so think I am pretty lucky to have that. They are up with the latest research and consider my other medical issues. I probably use more than you do when I do use it. 
    • kathleen65757
      kathleen65757 Morrell1951

      Posted

      I just went on line to find out how potent yours and mine actually were. The one/s you named were in the worst category and mine in the next one down but there was a big difference in potency. I think that is why mine was changed some time back because the previous one was in the worst potency group. It is also about the amount and frequency of use. So, if you use sparingly like you are doing, it is probably not much worse than what I do because I tend you use double what you mention. 
  • hanny32508
    hanny32508 Morrell1951

    Posted

    You may understand the difficulties - before I received this globetasol treatment for the LS, I was already suffering mall functioning Adrenal Glands. Isn't that what one calls - being stuck between a rock and a hard place.  Especially in the beginning when it is required to use the globetasol more frequently.  At present the use of a small amount is do-able.  Are there other LS people who have to cope with Adrenal Gland problems as well?
    • Morrell1951
      Morrell1951 hanny32508

      Posted

      The year I went cold turkey off the psoriasis ointments (2003) my face was puffing up as in Cushing's Syndrome. The internet wasn't what it is today, but I gathered that between thirty years of slathering it on my hands and arms and neck; decades of anger; a crazy high-pressure career starting in my forties; lots of air travel and restaurant food because of my job – I figured I was in adrenal fatigue (not as bad as failure). So you can imagine how I wouldn't have wanted to use Colbetasol on my vulva, if I had been diagnosed at that point. But by last summer when I was finally diagnosed, things were so bad I was able to regard it as the lesser of two evils.
  • kate207
    kate207 Morrell1951

    Posted

    Hi. I'm in Ireland, and the protocol here is that when your LS is under control to try once daily applications of over- the-counter1% hydrocortisone cream - this is a very low dose cream, about one hundred and fifty times weaker than the clob, so its very important never to miss a day.  You can go to twice or three times daily on the least suspicion of a flare-up. I havn't used clob for two years now and so far so good. Here's a link to a good site comparing relative steroid potencies:http://www.lichensclerosus.net/docs/TopicalSteroidsPOTENCY.pdf
    • Morrell1951
      Morrell1951 kate207

      Posted

      Right, Kate, I think it was you who wrote about this in another thread. I see my gynae in August and I'm going to ask her about this. For one thing, it would be much easier to remember to use it every day.
    • Morrell1951
      Morrell1951 kate207

      Posted

      Hey, they let you post a link! Will wonders never cease?
    • Morrell1951
      Morrell1951 kate207

      Posted

      Again, knowing I used 50 g. of clob in a whole year, this makes me feel OK: in that pdf it says:

      "If more than 50g of clobetasol propionate, or 500g of hydrocortisone is used per week, sufficient steroid may be absorbed through the skin to result in adrenal gland suppression and/or eventually Cushing's syndrome.

      • Adrenal Gland Suppression. Topical steroids can suppress the production of natural steroids, which are essential for healthy living. Stopping the steroids suddenly may then result in illness.

      • Cushing's Syndrome If large amounts of steroid are absorbed through the skin, fluid retention, raised blood pressure, diabetes etc. may result.

       

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