Expert clinic on lichen sclerosus

[talkhealth]

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[Guest222]

Hi, I am wondering what the protocol is for treatment when steroid ointment is failing to stop the spread of the LS - in my case white patches. I have been using the clobetasol 0.05% daily since February, following the advice from Dr Goldstein to soak the area first for 10 min in luke warm water , or at least after a shower and then gently massage ointment in to the area for 2 mins. No soap etc. I do this over the entire vulva area. Then apply a Danish brand fat cream similar to hydromol (Dr. Warming - containing paraffin) 30 mins later. I notice the white patches continue to spread despite diligent maintaining. I keep the area moist all day with aveeno also. I am trying some oils such as olive oil. Apparently coconut is drying. I soak in Epsom salts a couple of times a week too. The LS is also 'at the back'. And I have some with fusing around urethra and by perineum meaning dyspareunia. My gynecologist recommended I alternate between clobetasol and 0.03% protopic tacrolimus, since a month ago. The same time I was given 0.1%ovestin which I apply to whole vulva area. Gynecologist said there was some atrophy due to clobetasol.

Is there anything else that can be tried. I am 40 now, but had the symptoms since at least 37. Strength of ointments increased? Is tracolimus even recommended?
Many thanks indeed.

[Dr Karen Gibbon]

I'm sorry you're having such issues. LS can be unpredictable and continue to spread for a while before it starts to respond to therapy. If you've only been using clobetasol since Feb then atrophy is very unlikely. You are however using a lot of different products on your vulva and there is a potential for irritancy to develop to all these different therapies combined with different home remedies such as olive oil and Epsom salts. You may want to consider getting some allergy tests done in the form of patch testing to see if you've developed any allergic reactions to the different creams and therapies you've been using. I personally don't use tacrolimus on the vulva for LS. The dose you're referring to is very low and generally used for children.