Lichen Sclerosus day 5

Men's health
1

Greetings everyone. As the title suggests, today marks 5 days since my positive biopsy result for Lichen Sclerosus as well as my fifth day of using the prescribed steroid ointment.

Current progress, in all honesty, is quite lackluster compared to what my doctor predicted. The rough white marks/patches, although a little less severe, remain noticeable.

A red patch on my glans, previously thought to be Zoon's Balanitis, and now believed to be part of the LS seems to be aggravated by the steroid ointment which I am quite curious about.

I am currently applying the ointment twice daily, and will for the next day. After which I'll switch to application once daily for a week. The ointment I was prescribed is Diprosone.

I've also noticed my inner foreskin becoming a little painful at times, even occasionally aching, since starting the steroid ointment. Couldn't seem to find this as a listed side effect, so am unsure what the cause could be.

One last thing, which has been puzzling me. Prior to my doctor doing the biopsy, I was using anti-fungal cream to treat candida. During the week or so that I was using the cream, the white marks became much more raised and prominent. I'm not sure if the clotrimazole has any affect on LS symptoms, I will ask my doctor at my next appointment. 

I'll keep this post updated with any changes/progress I experience.

2

Hi cargs889, it could be the Diprosone is not suitable for your skin-type, and / or the severity of your condition.  I would give the Diprosone 3 or 4 weeks to see whether you achieve lasting positive impact from it, or whether you need to switch to another Steroid - as Clobetasol is now the widely acknowledged recommended treatment for LS in general.

Also, do you have the ointment or cream version?  For some, only the ointment versions give improvement.

You should not apply any other ointment, such as the clotrimazole.

Just to check, have you read any of my other posts on this site where I address LS / BXO in Males?  The important things you need to have in place is correct penile hygiene, AND doing regular foreskin stretches.

Hygiene: this is the basics of what I recommend >>> prevent as far as possible, soap, or shower gel, hair shampoo etc., or skin cream / lotion or any form of lube (oil based particularly) from getting on your penis.  Always wash with water ONLY (never hot water) after urinating (in public toilets go in a cubicle and use toilet paper to ensure the head and surrounding area is 100% dry) when showering – if possible, make sure the skin of the penis is drawn forward to cover the head to protect the area from soap / shower gel, etc. getting on it.  At the end of the shower - make sure the entire penis is 100% dry afterwards.  <<<

Your comment on the foreskin side-effects you are experiencing are likely to be very common, BUT, not talked about - particularly by the Medical profession.  This is my essential guide on overcoming this: you need to learn to become Skin Kindly towards your foreskin by keeping it as healthy as possible.  To achieve this you need to find the correct steroid you are applying that is right for your severity of condition, apply it correctly, AND, find the right frequency of application that is right for you.  AND, you need to find the correct foreskin stretches suitable for you - start by doing stretches gently, do these after having a shower.  The 2 basic stretches are i.) drawing the foreskin away from the glans, and, ii.) pulling the entire skin of the shaft of the penis towards the body.  If you have not done stretches like this before you need to start extremely gently, build the time you hold the stretch, the pressure you apply and the repetitions in which you do the stretches over an extended period of months.  Never, over a period of days or weeks - or use pressure levels in which you experience pain.

I do my stretches when I apply my Clobetasol - make sure you never get any steroid you use on the health skin / main shaft of the penis that is not infected.  ... If there is anything else you need me to specifically address, simply reply to this discussion thread ......

3

Hey Wee Dugie. Yes, I have the ointment at the moment. Do you ever get any thrush symptoms using the Clobetasol? I've read it is thought to sometimes cause candida do grow under the foreskin.

Also, I was not using the antifungal cream in conjunction with the diprosone. This occurred before my diagnosis, and as clitrimazole was the active ingredient in the anti fungal cream, I was wondering if it was known to exacerbate LS symptoms. Mainly the white marks.

I never use soap in the shower anyway. It doesn't agree with my skin. You mentioned you only apply the steroid cream to the affected areas. Are these areas still noticeable to you even with the use of the cream, or do you go by memory of where the marks were?

4

Interesting points Cargs - thrush symptoms, unless I am way-off beam are due due to not having the right penile hygiene regime in place.  Simply, the  candida yeast will only thrive where the right conditions exist.  There will most likely be an imbalance in the natural bacteria that exist on the glans being displaced by the yeast.

Therefore, as I have never had any thrush like symptoms I can only assume my naturally occurring 'good bacteria' is able to thrive as they should to protect the glans from the unhealthy 'predators'.  If you have a regular female sexual partner, there is often yeast present in the vagina that you may be getting regular contact with if you do not use barrier methods of protection every time you have sex.

Not sure on the anti-fungal cream and exacerbation of LS.  The base I work from is you need to keep as few things as possible from getting in contact with the entire foreskin and glans as possible.  Again, this is why I often use the term 'squeaky clean' Penile Hygiene regime - stuff that don't need to be there shouldn't - this includes medications that are not required, or otherwise have a deleterious impact on the area it is applied to.

In terms of applying the Clobetasol to my infected areas.  Yes, this is partly from memory - but also, knowing to apply it after washing / having a shower, or before going to bed.  You don't want to have the steroid on your fingertips then start grasping other areas of skin on the main shaft of the penis.

So for us uncircumcised guys there are two essentials: i.) get the treatment regime right - often this is the right steroid, correctly applied at the required frequency of application. AND ii.) not often acknowledged, but to prevent the foreskin from beginning the process of adhering to the glans the foreskin has to be stretched everyday.  I do this process where I apply the steriod by massaging it in - I then do my stretching of the foreskin.  The regular most effective one I do is to draw the entire skin of the shaft of the penis towards the base of the penis {toward the body) - in the early days I was caught out by thinning the uninfected areas of skin near the base of the penis.

My memory for application is also visually prompted because my LS / BXO mainly exists where I was eventually able to prise-apart my fully attached foreskin {Phimosis] from the main skin of the tip  of the shaft of my penis.  So, there is still a visual line where the 'perimeter' of the adhering skin actually was.  Otherwise, I know if I do not use the Clobetasol regularly enough where the white patches will appear and these would eventually turn to scarring marks if no topical application of a steroid occurred ... Hope this helps .....

 

5

Update 2: I've been using the Diprosone for nearly 3 weeks now. Currently, I am applying it twice weekly and will continue with this regimen until I see the urologist in about 3 weeks time. Perhaps they propose a change in steroid ointment or frequency of application.

The white marks have dramatically reduced in severity, and are almost invisible now. I have, however, noticed a decrease in foreskin flexibility as well as a mild wrinkled, shriveled appearance on the outer area of the foreskin where I am applying the Diprosone (on the inside). I can only assume this is due to the steroid ointment, as before commencing treatment, these symptoms were not apparent. Perhaps I am using too much ointment or applying it to unaffected skin. I'm more inclined to believe the latter, as I have been using a sample tube of Diprosone, given to me by my GP, for 3 weeks and am yet to halfway empty it.

Other than that, things are progressing very well. I'll provide another update after consulting with the Urologist, unless something happens between now and then.

 

6

Are you doing foreskin stretches ..... ?!

7

What size was the Diprosone you were given?  Should it be 100 gram - you are using far too much - 25 gram tube and you are okay .....

8

Yea, I am. The foreskin isn't right, just a little less flexible than before I started the steroid ointment.

9

It's a 5g tube.

10

I would certainly recommend that you ask the Urologist how to manage what is going on with your foreskin - I have just read a post by someone who was told by a Urologist to get circumcised "to cure" his LS - 2 years later he still has LS - so be vary-wary of any such suggestion!

I wonder if the Diprosone is the right 'formulation' to be dealing with LS - Clobetasol is now internationally recognised as the correct Steroid to prescribe for LS ....... 

11

Unless the Urologist can sign a piece of paper with his blood stating the LS will 100% disappear forever if I get circumcised, I won't be going down that route. Additionally, I'm only young, and with current medical progress, a cure for LS may be found soon (positive thinking).

I'm kinda of wondering if I should stop using the diprosone until I see the Urologist, which is 3 weeks from today. So i'll be missing 6 applications. I don't like the changes to my outer foreskin, and if it is the diprosone causing it, then maybe it's best if I stop it. Best way I can describe it is it's kind of taken on a dry texture, sort of how powder feels between your fingers.

12

Maybe your hunch is right.  I think the Urologist is a little over-cautious in the strength and level of application of the steroid you have been given.  Just so you are aware this is now the most widely internationally recognised way of treating LS, as, I have also started looking at what the research literature is saying on treating LS and of course, BXO in us Men ....

Clobetasol: " The regimen recommended ... for a newly diagnosed case is clobetasol propionate 0·05% ointment applied once daily, at night, for 4 weeks, then on alternate nights for 4 weeks, and then twice weekly for a further 4 weeks, before review "  (from the same Research Articlesmile

Also shown in one study was that: " [it] showed that 50% of men requiring circumcision continued to have lesions of LS "

CAN I JUST ASK, if you post a new thread / discussion on here at any time can you remind people who may be reading it for the first time: what your age is - when you first noticed something amiss on your penis - how far, chronologically you are from that point - when treatment was first started in terms of symptoms first appearing.  Thanks, I personally read that many on here and on the Female LS pages on this web site too, it is difficult to follow where everyone is at, in terms of their personal details .....

13

Update 3: I had my consultation with the Urologist yesterday and after he examined the area, he suspects I currently have Balanitis or a fungal infection (in addition to the LS, of course), as he noticed some irritation and swelling. I've also been experiencing some peeling/flaking of the skin on my glans and frenulum, which I mentioned to him. He has prescribed a cream called Resolve Plus 1.0 and wants me to apply it once a day for 1 month. I was quite surprised by this as this cream is predominantly used to treat fungal infections, though it is also used as an anti-inflammatory, but I suppose he is the expert.

14

Thanks for the update:  Just wonder if you made any mention of Clobetasol to the Urologist?  Are you still using the Diprosone as well?

Just for others who may be reading this - for Lichen Sclerosus in men the formal description is Balanitis Xerotica Obliterans (BXO) - or in short, one of the several types of Balanitis, or the more generic condition - which statistically affects far more Women than Men, is Lichen Sclerosus (LS) [this is my understanding at least].

*So, when the Urologist, you say, states you have "Balanitis" is it your understanding that they are talking about two specific conditions, or conflating different terms to refer to one overall disease condition of BXO?

15

I'm assuming he meant two separate conditions as he spoke about them in separate contexts. I told him about my reaction to the Diprosone, but he never specifically said to stop using it. I'm assuming it was implied as he's prescribed this new cream.

I am however confused as to what I do after the month of using this cream. Do I use it intermittently when symptoms arise? It does have a steroid in it so maybe that is the case. I'll double check with my GP at my next appointment.

16

You should only use ANY medication when you have been directed how to apply it correctly.  You should be applying it systematically rather than wait  for flare ups.  This is how so many people who use steroidal applications that ' they never did anything for me ' or ' they did not work ' they were given no regime to follow or specifc instruction on how to apply it and how frequently to use it ....