I have lichen planus and my dentist prescribed this medication for relief. Everything I read states do not use in the mouth. What is the best course of treatment for me?
Can I use Clobetasol Propionate in my mouth?
Question posted by GrammyKLS on 18 July 2014
Last updated on 25 June 2019
5 Answers
DrWadeT
25 June 2019
Hi All,
Just want to make sure this answer is correct on this page. Unfortunately, Tony Plake's response below is very incorrect. And it can be used in the mouth as a gel at .05%. It has been used for many years and is one of the most common treatments. His response is lengthy and seems just a copy and paste from a blanket website on the internet with no real experience or knowledge of the use orally. When this is the use, one will often develop Candidiasis and will need treated. (This is usually used for Erosive Lichen Planus.)
Dentists have the most experience in training in this aspect because is an off label use, so having the knowledge of only google doesn't help. I often instruct my Pharmacies of the use when prescribe and they are very thankful for the knowledge.
Please be careful when you see blanket statements like Tonys.
His response starts like this and is not correct.
"Hi, GrammyKLS,
You most certainly CANNOT use Clobetasol Propionate in your mouth. It is a STRONG topical steroid that is only to be used on your skin OUTSIDE the body on the feet or pads of the fingers/hand, and typically used along with Topicort for 2nd and 3rd degree burn victims.
masso
25 June 2019
Hi DR.,
With all due respect, if someone is incorrect, try to educate people not put them down and have fun doing it.
The facts are: answering the questions.
You are a knowledgeable person, so share your knowledge and respect others, educate do not mock other members.
-
DrWadeT
25 June 2019
HI Masso,
Sorry if you read this other than factual. When in discussion of medication and the human body, one must accurate. Capital letters, as many feel, should be used with extreme accuracy not inaccuracy. And making sure when people look for correct information, it should be available. If comments like Tony's could be removed it would it benefit all looking for the correct information. If one doesn't have the experience or education, one should release this information for the safety of others. When discussing medication information, safety and accuracy are most important.
Paula3121
25 June 2019
My dr prescribe triamcinolone acetonide to swish and spit and that help with inflammation also I was also prescribed
dexamethasone and has also help
Try to eat bland foods and soft foods till the sores go away that helped me.
Hope it helps
masso
25 June 2019
Hello DR.,
Welcome to the site.
I most certainly agree with you, but rather than mock the member, you should report his/her answer (s). There is an option with the sign of a flag, it says report , just click on it and it will take you to the link where you can choose an option and add your comment in order for the site administrators and moderators to remove the question if they see it fit.
DrWadeT
25 June 2019
Hi again Masso,
I am not sure why you are stating anything is mocking, nothing I have said is humorous or points fun in any direction. Just making a valuable correction on important information and identifying an incorrect medical statement of another. Which is important. Thanks for the concern and update on the flag. Enjoy.
clcnca
25 June 2019
DrWadeT,
I was diagnosed with Oral LP 18 years ago. Four years ago I moved and saw a new dentist who refered me to an oral cancer specialist. (He treats many ailments from the neck up.. I don't have cancer) I was prescribed Clobetasol Gel .05% - not cream - via trays (prepared for me by my dentist to fit my mouth exactly) that I squeeze the gel in and smooth out with a Q-tip then wear them overnight. It is magic. Prior to this, I was taking a rejection drug given to transplant patients. At first (3-4 months) it helped. Then the same old pain & rawness re-appeared. The dermatologist kept upping the number of pills to the point I was taking 10+. Then we tried Protopic $$$$ - didn't touch it. So I moved on to another physician in my new state. I am fortunate that most of my irritation occurs on my gums. I find my trigger is stress...
when I've found myself under extreme stress, it sometimes acts up on one of my cheeks - and it's usually because I haven't been wearing my trays regular enough. Bottom line, thank you for your affirmation that it is safe. I've been using it for 4 years. The Gel form is expensive but well worth the results. I appreciate you being firm with the incorrect info regarding use of Clobetasol Gel in the mouth and was not offended a bit by your response.
Zoftig543
13 March 2017
I was prescribed Clobetasol Propionate by an oral surgeon several years ago with the advice:"Ignore the warning to not use in the mouth". If used judiciously it can be very effecive. You must dry the area first and then apply the cream in very small amounts, rubbing it in. I find it most effective when I apply it right before bedtime. The inflammation/irritation usually subsides with 2-3 applications. The same is also true of another prednisone rx: Lidex.
Kath51
16 Nov 2016
Yes you can use it. My oral pathologist who specializes in LP prescribed it. I use 1/8 tsp of the gel twice a day. I swish it in my mouth for 2 minutes then spit it out. Then spit twice more when saliva builds up enough. I do not swallow it. Wait 1 hour before eating or drinking.
tonyplake
18 July 2014
Hi, GrammyKLS,
You most certainly CANNOT use Clobetasol Propionate in your mouth. It is a STRONG topical steroid that is only to be used on your skin OUTSIDE the body on the feet or pads of the fingers/hand, and typically used along with Topicort for 2nd and 3rd degree burn victims.
+++
From Mayo Clinic's website:
Oral Lichen Planus is an ongoing (chronic) inflammatory condition that affects mucous membranes inside your mouth. Oral lichen planus may appear as white, lacy patches; red, swollen tissues; or open sores. These lesions may cause burning, pain or other discomfort.
Oral lichen planus can't be passed from one person to another. The disorder occurs when the immune system mounts an attack against cells of the oral mucous membranes for unknown reasons (autoimmune disorder).
Symptoms can usually be managed, but people who have oral lichen planus need regular monitoring because they may be at risk of developing mouth cancer in the affected areas.
The cause of it is unknown. However, in some people, certain factors, such as those below, may trigger an inflammatory disorder:
Hepatitis C infection and other types of liver disease
Hepatitis B vaccine
Allergy-causing agents (allergens), such as foods, dental materials or other substances
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve, others)
Certain medications for heart disease, high blood pressure or arthritis.
Oral lichen planus is a chronic condition, so the treatment goals focus on helping severe lesions heal and reducing pain or other discomfort. Your doctor will monitor your condition to increase or decrease dosages, change medications or stop treatment as necessary.
If you have no pain or discomfort and if only white, lacy lesions are present, you may not need any treatment. For more severe symptoms, you may need one or more of the options below.
Symptomatic treatments
Treatments such as topical numbing agents can be used to provide temporary relief for areas that are particularly painful.
Corticosteroids
Corticosteroids may reduce inflammation related to oral lichen planus. Side effects vary, depending on whether corticosteroids are used as a mouthwash, ointment or gel applied directly to the mucous membrane (topical), given as an injection directly into the lesion, or taken as a pill (oral). Topical is the preferred method for corticosteroid use with oral lichen planus. Talk with your doctor to weigh the potential benefits against possible side effects.
Retinoids
Retinoids are synthetic versions of vitamin A that can be applied as a topical ointment or taken orally, but they're not commonly used to treat oral lichen planus. Topical treatment may irritate the mucous membranes of your mouth.
Because both topical and oral retinoids can cause birth defects, the drug shouldn't be used by women who are pregnant or planning to become pregnant in the near future. Your doctor can advise you on necessary precautions.
Immune response medicines
Medications that suppress or modify your body's immune response may be used as ointments, gels or oral medication. Treatments that suppress immune system abnormalities may improve more severe lesions and lessen pain.
For example, several reports have shown the effectiveness of topical medications, called calcineurin inhibitors, which are closely related to or identical to oral medications used to prevent rejection of transplanted organs. These treatments appear to be effective for the treatment of oral lichen planus. However, packaging for these medications carries a Food and Drug Administration (FDA) warning because of an unclear association with cancer. Examples of these topical medications include tacrolimus (Protopic) and pimecrolimus (Elidel).
For severe cases where oral lichen planus also involves other areas — such as the scalp, genitalia or esophagus — systemic medications that suppress the immune system may be used. However, these are seldom used for oral lichen planus unless other parts of the body also are affected.
Dealing with triggers
If your doctor suspects that oral lichen planus may be related to a drug you take, or to a hepatitis C infection, an allergen or stress, he or she will recommend how to address the trigger. These actions may include:
Drugs. Your doctor may ask you to stop taking a drug that can be a trigger or to try another drug instead. This may require discussion with the doctor who originally prescribed your medication.
Hepatitis C. You'll likely be referred to a specialist in infectious diseases or a specialist in liver disease (hepatologist) for further diagnostic evaluation and disease management.
Allergen. If tests suggest that an allergen may be a potential trigger, you'll be advised to avoid the allergen. You may need to see a dermatologist or an allergist for additional testing, such as allergy skin patch testing. If a dental device is a suspected allergen, you may need to see your dentist to have dental materials removed and replaced.
Limiting oral trauma. Performing gentle oral cleaning and choosing foods that are soft may help limit the discomfort associated with oral lichen planus.
Stress. Because stress may complicate symptoms or trigger symptom recurrence, you may need to develop skills to avoid or manage stress. Your doctor may refer you to a mental health specialist who can help you identify stressors, develop stress management strategies or address other mental health concerns.
+++
I would definitely see another dentist for a second opinion about your treatment options, since the prescribing dentist for Clobetasol is entirely wrong.
Good luck to you and all the very best to you,
Tony
sww4390
14 April 2015
From your Mayo reference:
"Corticosteroids
Corticosteroids may reduce inflammation related to oral lichen planus. Side effects vary, depending on whether corticosteroids are used as a mouthwash, ointment or gel applied directly to the mucous membrane (topical), given as an injection directly into the lesion, or taken as a pill (oral). Topical is the preferred method for corticosteroid use with oral lichen planus. Talk with your doctor to weigh the potential benefits against possible side effects."
I am a dentist and am looking for a good, safe, topical corticosteroid to prescribe. My book, "Oral and Maxillofacial Pathology," written by Neville, Damm, Allen, and Bouquot, suggests using fluocinide, betamethasone, or clobetasol gel to treat erosive lichen planus.
So a different type of clobetasol, if there is one? Why attack the prescribing dentist when he is just trying to help? Mayo clinic seems to agree with this "entirely wrong" dentist rather than you.
And the question is still unanswered, as far as alternatives to this very difficult problem.
sww4390
14 April 2015
"My book" from my earlier post means the textbook I own. I did not help to write the book.
LISAMirisa
5 July 2017
My dermatologist specializes in oral care and he is a former dentist. He prescribe clobetasol gel and dexamethasone rinse for oral lichenplanus. Been using it for 15 years twice a week.
DrWadeT
25 June 2019
Tony is very incorrect. You can read my response in the thread. Unfortunately when people do have the knowledge, training or experience they can be confused. My response is below in the thread if you would prefer a correct and clear understanding.
kaismama
18 July 2014
The problem is that there isn't much in meds for the mouth. You can't miss the warning on the clobetasol that's for sure. The first thing I'd do is check in with my pharmacist about it. Maybe he knows something we don't. If he's concerned then I'd check with the dentist. Taking prednisone pills may be an option, I don't know.
Related topics
lichen planus, clobetasol, prescription, mouth, medication, treatment
Further information
- Clobetasol uses and safety info
- Clobetasol prescribing info & package insert (for Health Professionals)
- Side effects of Clobetasol (detailed)
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