Re: F/U QUESTION TO DR. MARCHBEIN: RE: Worried Sick - Vaginal Burning/Irritation
From: Harvey S. Marchbein, M.D. (anonymous@obgyn.net)
Mon, 25 Dec 2000 20:42:24 -0600 (CST)
Clobetasol has been used for months and even years. It might be that
your doctor feels that if your symptoms aren't resolved in 2 weeks that
further investigation is needed.
Long term therapy has been discussed with it's success rate in:
"Clobetasol dipropionate 0.05% versus testosterone propionate 2% topical
application for severe vulvar lichen sclerosus."Am J Obstet Gynecol 1998
Jan;178(1 Pt 1):80-4
"Testosterone maintenance therapy. Effects on vulvar lichen sclerosus
treated with clobetasol propionate."
J Reprod Med 1996 Feb;41(2):99-102
"[La nostra esperienza nel trattamento del lichen sclerosus vulvare.]"
Minerva Ginecol 1997 May;49(5):207-12
And this paper discussed starting with Clobetasol and gradually reducing
steroid therapy strength with weaker steroids as symptoms ameliorated.
"Lichen sclerosus of the vulva. Long-term steroid maintenance
therapy."J Reprod Med 1999 Jul;44(7):621-4
As far as burning, even if Clobetasol is the right therapy, it can burn
for several days until the inflammation subsides somewhat. If it
continues, a vulvar biopsy should be done to evaluate a non-responsive
skin condition (as any dermatologist would do).
HSM
At Mon, 25 Dec 2000, LM wrote:
>
>Dr Marchbein:
>
>My GYN has just prescribed Clobetasol, but he says it is too strong to
>use for more than 2x per day for 2 weeks. Is that correct? Also, it
>causes burning for me. Is that normal? Thanks so much for your help.
>
>At Sat, 23 Dec 2000, Harvey S. Marchbein, M.D. wrote:
>>
>>If it's external (vulvitis) and it's been proven to not be an infection,
>>sometimes a skin biopsy is necessary to evaluate this. Many times,
>>Clobetasol, a stronger cortisone, used twice a day for up to 3 months
>>(or longer) is worth a try.
>>
>>Hope this helps and write back anytime for more information.
>>
>>HSM
>>
>>At Sat, 23 Dec 2000, LM wrote:
>>>
>>>I am 33 years old and a virgin. I have never had any vaginal problems
>>>including yeast infections or UTIs. My last Pelvic/Pap was in March and
>>>it was normal. In April, I suddenly started developing burning and
>>>irritation in my vaginal area. I have no discharge, itchiness, or odor.
>>>I tried everything including using Dreft and Dove soap. My GYN
>>>prescribed various creams which provided some relief. After about 3
>>>months, he had me try Hydrocortizone 1% 4X per day for 2 weeks, which
>>>really improved my symptoms. Since then, my symptoms are about 80%
>>>better but I still suffer with some discomfort nearly everyday and I am
>>>desperate.
>>>
>>>Can anyone suggest a treatment that could help? Should I go back to the
>>>Hydrocortizone? What else can be done for me? Thanks for your help.
--
Harvey S. Marchbein, M.D. FACOG, FACS
Great Neck, New York
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