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?
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.
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.
Treatments such as topical numbing agents can be used to provide temporary relief for areas that are particularly painful.
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 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,
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.
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.
- Clobetasol Information for Consumers
- Clobetasol Information for Healthcare Professionals (includes dosage details)
- Side Effects of Clobetasol (detailed)
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