Patient advice for women requiring a highly-potent topical steroid (for example Dermovate® cream or ointment with active ingredient of clobetasol propionate

Who is the information for? What is its aim?

This page is for you if you have been prescribed a high-potency topical steroid cream or ointment to treat the symptoms you have in your vulval area. Often the symptoms are caused by a condition called lichen sclerosus.

The aim of the page is to explain how to use the cream, how long to continue the treatment and any benefits and risks involved.

What is the vulva?

The vulva is the name given to the external female genitals, this being different from the vagina which is internal.

Application

Please print off this section to fill in the blanks.

You have been prescribed Dermovate® cream/ointment/other: __________ to use as treatment to the vulval area to help to relieve your symptoms.

• Apply the cream or ointment by spreading it thinly on the skin but in sufficient quantity to cover the affected areas
• For the whole groin and genitalia, a 15 – 30g tube is usually suitable for an adult for a single daily application for two to four weeks. If treating a smaller area, the tube will last longer.
• One fingertip length of cream /ointment (from the tip of the index finger to the first crease) is sufficient to cover an area that is twice that of the flat adult palm
• Apply the cream/ointment to the affected area according to your regime prescribed to you today:

Then stop the above dose regime, and switch to:

• Once a week for one month
• After this time gradually reduce the use once or twice a week only.

If the symptoms return, you should go back to using the cream daily for 2 weeks before reducing the usage again when your symptoms eases. This can be repeated as required.

Follow up

You will be reviewed in the clinic or by your GP to assess symptom control and to make sure that the treatment is working as it should be. It is important to attend for your follow up even if your symptoms have settled. At this visit you will be examined and future management will be discussed. If there is no improvement in the condition or the symptoms are worsening then you may be required to have a biopsy of the area affected.

Please see your GP once a year for review to make sure no new abnormality has developed.

If you have any queries then you can either contact the department using the telephone numbers given or speak to your GP.

Benefits

• Improving the condition, including your symptoms.
• Preventing the condition from progressing.

No treatment is likely to reverse the changes of lichen sclerosus completely, but the symptoms and signs of the disease can usually be well controlled with the application of a steroid.

Risks (side effects)

In order to minimise the side effects of a topical corticosteroid it is important to apply it thinly. If you become sensitive to the cream or ointment you will notice prolonged stinging for one to two hours after application. If this occurs, stop using the cream and wash the area thoroughly. It is quite usual however, to have stinging for some minutes after applying the cream or ointment.

The treatment is associated with few side effects but care is required. Local side effects include:

• spread and worsening of untreated infection (such as thrush)
• thinning of the skin making it look more pink, which may be restored over a period after stopping treatment
• contact dermatitis (allergy to the cream or ointment).

Alternatives

You are entitled to not have treatment. The most appropriate active treatment is the steroid cream but bland moisturisers help to soften and protect the skin.

Contacts / further information

If you have any queries or concerns then contact the clinic where your cream/ointment was prescribed ask to speak to the specialist nurse:

• Colposcopy: 01223 216603
• Dermatology: 01223 217391

If you have any drug-related questions, please contact the medicines information centre of our Trust Monday to Friday from 9am to 5pm. The contact details are:

• 01223 217502.

References / sources of evidence

• National Lichen Sclerosus Support Group (opens in a new tab)
• Neill et al British Association of Dermatologists' guidelines for the management of lichen sclerosus (2010) British Journal of Dermatology 2010 Oct;163 (4):672-82