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Questions and Answers
- Q
- I am a 64-year-old Caucasian circumsized male. About 2 years ago, I began
to experience pain during intercourse. It appeared that the skin on the
underside of the penis had torn slightly. My wife is fairly dry, so we
began to use a lubricant. The condition persisted, so I consulted a
dermatologist.
A biopsy indicated liken sclerosis et atrophicus. The doctor tried
several topical remedies, the last of which was Temovate. After 2 or 3
weeks using Temovate, I noticed that my erection was beginning to bend
upward.
I mentioned this to the dermatologist, who suggested I see a urologist.
The urologist diagnosed me as having Peyronie's disease, and put me on
vitamin E (400 units a day) and vitamin B complex (B-50.) He didn't
think the Temovate could have caused this condition, but the coincidence
is disturbing. He said the cause and cure was unknown, but the
problem was self-limiting and might well get better.
The skin condition had improved markedly, so I did not return to the
dermatologist.
The bend has worsened over the last 9 months to about a 60-degree angle.
I can still have intercourse, but it has to be done very carefully, or it
becomes painful. Meanwhile, the irritation on the underside of the penis
has returned.
Any suggestions regarding this "double-whammy"? I am not ready to resort
to surgery until I absolutely have to.
- A
- ... sorry to hear of your problems ...
Temovate (clobetasol propionate) is one of the four most potent of over 35
topical steroid preparations in the U.S.A. ... your Lichen is one of the
several conditions that usually respond well to topical corticosteroids ...
the first guideline in their use , however, is to use the lowest potency
steroid for the shortest period of time ... increase to higher potency
preparations is indicated by a poor response ... this is likely your
physician's philosophy in trying 'several topical remedies' . The chance of
an association between steroid use and your developing a bend seems very
remote (I can find no such reference in the literature)
Peyronie's is caused by the development of a plaque in layers containing
erectile tissue ... it begins as a localized inflammation, which leads away
from steroids because of their potent anti-inflammatory action, and can
develop into a hard scar. Since the plaque often shrinks or disappears
without treatment , it is usually recommended to wait 1 to 2 years or longer
before considering surgery ... and then only in men whose curvature is so
severe that it prevents sexual intercourse. There are some reports of
beneficial effects from administering vitamin A and para-aminobenzoate (a
B-vitamin) but results have been pretty inconclusive.
It appears that your Lichen is returning ... you should pay another visit
to your dermatologist.
Best wishes.