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How do you apply clobetasol propionate for lichen sclerosus (lichen sclerosis)?

Medically reviewed by Carmen Fookes, BPharm. Last updated on July 22, 2020.

Official Answer

by Drugs.com

To treat lichen sclerosus, apply a small amount (0.5g or one fingertip unit) of clobetasol propionate thinly, once a day to the affected area, for up to 12 weeks or as directed by your doctor. Rub it in gently. Do not apply this medicine over a large area of skin unless your doctor has told you to.

Once this baseline treatment course has finished, clobetasol propionate may be continued to be used sporadically as needed to stem any recurrence in symptoms, if this course of action has been recommended by your doctor. Do not keep applying clobetasol propionate for long periods continuously without the advice of your doctor.

Clobetasol propionate ointment is usually preferable for cream as it will adhere to the affected area for longer.

Clobetasol propionate is an ultra-potent (also called a super potent) corticosteroid and research has shown that treatment for 12 weeks significantly improves symptoms of lichen sclerosus in 75% to 90% of patients, compared to only 10% of patients given a placebo ointment (a pretend ointment).

Untreated lichen sclerosus is associated with a greater degree of scarring and an elevated risk of cancer in the genital area. Topical calcineurin inhibitors, such as pimecrolimus or tacrolimus, may be considered as second-line treatment. If treatment is unsuccessful in boys and men, circumcision may be considered.

What is lichen sclerosus?

Lichen sclerosus is a common skin condition that most often affects the genital or perianal regions.

It is ten times more common in women than men and usually affects women over the age of 50. Children can also be affected, and it commonly runs in families, with 15% reporting another family member with the condition. It often co-exists with an autoimmune disorder such as thyroid disease, pernicious anemia, alopecia areata, or another skin condition such as psoriasis, lichen simplex (a well-defined area of thickened skin resulting from repeated rubbing, itching, and scratching of the skin), vitiligo (an acquired depigmenting disorder of the skin) or morphea (a thickening of the skin due to excessive collagen deposition).

Symptoms of lichen sclerosus include itching (96%), irritation (61%), burning, and dyspareunia (pain during sexual intercourse). It most commonly affects the labia, clitoris, perineum, and less commonly the perianal region.

Lichen sclerosus can start at any age, although it is most often diagnosed in women over 50. Pre-pubertal children can also be affected.

References
  • Kirtschig G. Lichen Sclerosus-Presentation, Diagnosis and Management. Dtsch Arztebl Int. 2016;113(19):337-343. doi:10.3238/arztebl.2016.0337
  • Lorenz B, Kaufman RH, Kutzner SK. Lichen sclerosus. Therapy with clobetasol propionate. J Reprod Med. 1998;43(9):790-794.
  • Kirtschig G. Lichen Sclerosus-Presentation, Diagnosis and Management. Dtsch Arztebl Int. 2016;113(19):337-343. doi:10.3238/arztebl.2016.0337

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