Topical clobetasol urged for lichen sclerosus tx. (Patient Education, Support Key).

HOUSTON -- Ultrapotent topical clobetasol should be the mainstay of treatment for genital lichen sclerosus, despite a widely held belief that it shouldn't be used on the vulva, according to Dr. Elizabeth Edwards.

Studies comparing clobetasol ointment to 2% topical testosterone propionate in petrolatum and the vehicle alone have shown the steroid to be vastly superior at relieving vulvar symptoms and reversing the disease course, Dr. Edwards said at a conference on vulvovaginal diseases sponsored by Baylor College of Medicine.

Testosterone was no better than plain petrolatum and was associated with masculinizing side effects such as increased facial hair, clitoral hypertrophy, and deepening of the voice.

Dr. Edwards has her patients apply Temovate (clobetasol propionate) to the area twice a day until the skin is entirely cleared, which could take as long as 4 months. She warns patients that diligent application is important, because some portions of the skin may heal more quickly than others.

During this time, she follows patients at monthly visits, checking for complications such as skin atrophy. When the lesions are gone, patients apply the steroid on a thrice-a-week schedule and are followed up every 6 months.

Temovate should not be used on hair-bearing regions of the labia majora, crural crease, or perianal skin, because those areas atrophy quickly and readily develop steroid dermatitis.

She prescribes Temovate because patients who tried generic clobetasol complained that it was less effective, said Dr. Edwards of Wake Forest University, Winston-Salem, N.C. She has no financial ties to Glaxo Wellcome, the company that makes Temovate.