Using Cortisone to treat vulval conditions
Many skin conditions which affect the vulva are treated with cortisone creams and ointment. This includes dermatitis, psoriasis, lichen sclerosus and lichen planus.
Cortisone is a very valuable medication for all of these conditions: we would have a lot of trouble treating them effectively without it. It is definitely the right treatment.
However, there has been a lot of bad publicity about cortisone creams lately. They have developed a really bad reputation which is completely unjustified. There are many reasons for this: misinformation on the internet, horror stories from family and friends who are probably mixing up the side effects of cream with high dose cortisone given by mouth and sometimes even advice from health professionals who aren’t sure how to use these products.
One of the main reasons people are scared of cortisone is advice given when you purchase it from the chemist. Chemists have a duty to warn you about possible side effects. They are correct to do this and take their responsibility seriously. Unfortunately the things they say may be misinterpreted by patients to sound very frightening.
If your doctor has told you to use a cortisone cream and your chemist says something that doesn't seem to agree with what your doctor told you, just call you doctor and double check. He or she would rather you do that than not use your treatment.
Are cortisone creams safe?
Yes, cortisone creams are very safe. Like all medications, they must be used within safe guidelines. This involves using the right strength of cream depending on the part of your skin being treated and the severity of your condition. The length of time you are treated for is also important. You shouldn’t keep using a strong cream after you are better and your skin is back to normal. At this stage you need something weaker for ongoing treatment.
Any medication if used in overdose will be dangerous. This is true of cortisone creams too, but the side effects you have heard of all relate to over-use, not normal use.
Won’t cortisone thin my skin?
If strong cortisone is used for long periods of time on the vulva it will do three things:
- Make the skin fragile so it tears easily.
- Cause redness and a burning sensation.
- Cause stretch marks around the anal area
The first 2 side effects recover rapidly when the cream is stopped. Cortisone does not produce permanently thin skin when used on the vulva. If you have accidentally used too much cortisone, the side effects will wear off when you stop it.
If stretch marks have developed, these are permanent. However to produce this side effect, you would have to have really overused a strong cortisone cream.
The sorts of weak cortisones that are available over the counter are very safe and will not produce these side effects: this is why they are able to be obtained without a prescription.
How do I know which are the strong and which are the weak cortisones?
There is only one weak cortisone available: hydrocortisone, which comes in two strengths 1% and 0.5%.
Because it is a weak cortisone it is available without a prescription.
You will notice when you look at the ingredients of a cortisone cream that they usually come as one of these two strengths: 1% and 0.5%. However you cannot compare them according to this. You just have to know which ones are weak, medium and strong. So have a look at the names of the creams below.
The following Australian brands contain hydrocortisone:
There are two cortisones slightly stronger than hydrocortisone:
- Desonide (Desowen®)
- Clobetasone butyrate (Becoderm-C®).
Strong cortisones that are used to treat vulval disease include:
- Methylprednisolone aceponate (Advantan®)
- Mometasone furoate (Novasone®, Elocon®)
The following are very potent cortisones that are used to treat lichen sclerosus, lichen planus and very severe dermatitis:
- Betamethasone dipropionate (Diprosone® and Diprosone OV®, Eleuphrat®)
- Clobetasol propionate (from compounding chemists)
- Betamethasone valerate (Betnovate®, Celestone®, Antroquoril®)
- Trimacinolone (Aristocort®)
In general, these are usually prescribed by specialists.
The following cortisones are NOT suitable to use on the vulva as they are more likely than others to cause side effects:
How do I know how long to use the creams for?
Usually you will be started with a strong cream to bring your problem under control. You should use this until you are better, but then you need to reduce to a weaker cream that is suitable for either long term maintenance or to treat any relapses that may occur.
Do not ever keep using a strong cream indefinitely unless you have been told to by your doctor and are being monitored.
What are the long term risks?
If you are using your creams appropriately, there are no long term risks. In the case of lichen sclerosus, you will probably be using some degree of cortisone cream for the rest of your life. This is proven, accepted treatment in this condition. Your doctor will make sure you are using the appropriate strength that is safe long term.
You cannot affect your immune system at all with cortisone on your vulval skin because it is such a small area of skin. Furthermore, for most conditions other lichen sclerosus the use of cortisone is on an intermittent basis. When they are used like this there is rarely any problem.
For other skin conditions, the use of cortisone tends to be on a more intermittent basis. When they are used like this there is rarely any problem.
Please don’t be scared to use your treatment. So many patients stop because it’s been a while since they saw their doctor and so many other people have been telling them about the dangers of cortisone. If you are not sure what to do, go back and have a talk to your doctor.
What cortisone is best for me?
Even though we talk about cortisone creams, in fact ointments (which have a clear, Vaseline like base) are best for the vulva. They are easier to apply and less likely to cause stinging.
However, some people find ointments too greasy. If you use a cream, that is OK but if it stings, change back to an ointment.
Some cortisones are mixtures of cortisone + antifungal (eg Hydrozole®). You should only use such creams if you have thrush. Using antifungals long term can become irritating.
Be guided by your doctor about what cream to use.
If you are buying cortisone over the counter, don’t be too put off by warnings about how dangerous it is. You CAN use it for more than 3 days, in fact you can use it as much as you like, but if you aren’t getting better, see your doctor.