Re: Gyn: Perineal scarring
From: Ronald Ainsworth (ainsron@sbcglobal.net)
Wed Aug 27 14:26:42 2008
Creams and lotions have alcohol in them and can cause
more burning, i.e. the patient won't complete therapy
because it makes their symptoms worse.
Ron
--- Henry Gregor <henrygregor@yahoo.com> wrote:
> Joaane,
>
> Help me here with year two med school basic
> question...why the ointment and not the cream? (It
> was foreordained I couldn't go into
> dermatology..never could keep the differences among
> ointments, creams and lotions and rationeales for
> uses straight in my mind, hehe.)
> Hank
>
> --- On Tue, 8/26/08, Joanne Bulley, MD
> <islesannie@gmail.com> wrote:
>
> From: Joanne Bulley, MD <islesannie@gmail.com>
> Subject: Re: Gyn: Perineal scarring
> To: "Multiple recipients of list OB-GYN-L"
> <ob-gyn-l@mail.obgyn.net>
> Date: Tuesday, August 26, 2008, 8:51 PM
>
> If she says the clobetasol didn't work - she was
> probably given a cream
> or lotion - must use OINTMENT - 0.05%
>
> If I were 100% convinced it was surgical scarring I
> would use estrace
> cream BID (even if the rest of the area looks well
> estrogenized.
>
> But see how the histology compares to L Margesson's
> info on that
> powerpoint link I sent.
>
> By the way - I don't know about others but for local
> estrogen cream I do
> only use Estrace: I want 17 Beta E2 -- not equine
> estrogens or
> estropipate. I would rather give the cells the
> identical molecule that
> the ovarian granulosa cells made / make.
>
> Joanne
> (just my bias and $0.02!)
>
> At Tue, 26 Aug 2008, Garry E. Siegel, M.D. wrote:
> >
> >51 YO menopausal 5005 who is S/P LAVH years ago,
> and subsequently had
> >pelvic reconstruction surgery with an academically
> based urogyn a few
> >years ago for a rectocele and lax perineum (no
> grafts). I did her LAVH
> >and haven't seen her since referral to the urogyn.
> >
> >She has seen another gyn who diagnosed lichen
> sclerosus without a biopsy
> >(per the patient) and clobetasol was "too strong"
> and didn't
> help.
> >
> >She has perineal discomfort and no sex drive, and
> is not on HRT.
> >
> >On exam, her perineum is whitened and scarred
> looking, like from
> >surgery, and is not reminiscent of LSA. The labia
> and clitoris are
> >normal. Her vagina is well estrogenized, the
> introitus admits two
> >fingers comfortably, and the length and depth are
> well preserved.
> >
> >The biopsy shows "Benign epithelial hyperplasia
> with overlying
> >keratosis."
> >
> >My instinct is to use medium potency steroids
> regularly, and address sex
> >drive, also.
> >
> >Any thoughts are welcome, and what dose/schedule of
> steroid would you
> >use?
> >
> >Garry
> >
> >--
> >Garry E. Siegel, M.D.
> >Private Practice
> >Roswell, GA
> >
>
> --
> Joanne Bulley, MD
> solo gyn
> Keene, NH
>
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