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Betnovate Cream

October 22 2006 at 7:04 AM
George  (no login)

 
Im 36 and developed a problem with a white crusty ring on the foreskin. Retraction was difficult but not impossible.

I read a bit and figured out I needed to see my doctor. The first thing he said was circumsision but prescribed betamethasone 0.1 as a trial although he said he didnt expect it to work.

I tried it and the results were encouraging, everything that was visble on the outside cleared up within a week. When pulling the foreskin back which is not a problem at all now there were a couple of patches of white skin and also a tight band. I coninued to work on these areas with the cream as well as doing a bit of stretching.

All was going well, the white patches have all but gone and the rough parts on the tighter ring were clearing up too.

I was a bit worried about the look of the Glans, it seemed to become dry and dull after I started to use the cream, also when working the cream into the areas concerned i could see that I was overlaping good skin a bit. Should have used a cotton bud and asked for the ointment I think.

Anyway I seem to have really hit a setback. A couple of days ago all of the skin went very pulpy and white looking. I was terrified and still am. The Glans is maybe a bit grayer than before. I thought this must be a reaction to the cream and stopped using it. The pulpy texture of the skin has cleared up but the whole area is still very white and unhappy looking

Im worried about leaving this to see if it improves, Think I need to see the doctor again but given his first reaction I want to be armed. I dont want to loose my foreskin or anything else.

Have any of you guys heard of anything like this? Do you have any information on the side effects of the cream? Can you point me to any web pages, notes or lectures that I can read. Any help would be great. Reading some of the other posts has helped but im very worried.

Thanks.




 
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AuthorReply

(Login Paul_B.)

Don't Panic!

October 22 2006, 3:31 PM 

Hello there George.

Interesting story there.

It sounds like a good example of what I was detailing just yesterday in this message thread regarding the dreaded condition called Lichen Sclerosis or where one really wishes it to be more fear-provoking, "BXO" (Balanitis Xerotica Obliterans) - a term which is no longer used by up-to-date doctors, and is essentially a shorthand for "I want to do a circumcision".

In your case, the onset as an adult and the whitish scaly patches are quite typical if not diagnostic of LS. If you really want to confirm the diagnosis, you get a piece of one of the patches biopsied (i.e., cut a piece out) and send it to a histopathology lab.

But now you see, you've made it impractical to do so, as you have gone and cured the jolly thing, which demonstrates what I was saying in the other thread - the condition probably does occur from time to time, but in most cases a mild form which responds promptly to proper treatment - as you essentially have implemented - and only in a small proportion is "difficult" to control, and even then, the steroid remains the first-line treatment.

Nevertheless, I must say that it may well come back again at some stage, and on one or more occasions. And if it does, the treatment is exactly the same - you use the steroid cream or ointment to clear it up, just as with every other person who suffers recurrent or persistent dermatitis - and you will find plenty of those.

Now I may in this preamble so far appear to be ignoring this "setback" you describe. Not so! This problem is clearly different - a different appearance, a broader area and a quite sudden onset - not like the first problem, is it? This is in fact, very typical of Candidal ("Thrush") super-infection which is certainly the most significant potential side-effect of use of the steroid, as it does tend to suppress the local skin immunity to fungal infection.

And the treatment for that is quite straightforward - you use a topical antifungal cream such as clotrimazole (Canesten® or Lotrimin®, but there are various others), or you might choose to use the oral approach - a once-a-week tablet of fluconazole (Diflucan®). There is in fact, some significant argument for using these "just in case" whenever you use the steroid in this area which is more than other regions of the body, prone to these yeast/ fungal infections.

Certainly, once the anti-fungal is implemented, you can go back to using the steroid - if it is still needed, and of course, there is some value to treating the affected areas for at least a week or two after they appear to have resolved.

May I say that the description of your approach to the whole situation is quite commendable - for example, rather than criticising you for not being sufficiently accurate in your application of the steroid, I am impressed that you discerned the need for accuracy. I presume you have been applying the cream by stretching your foreskin back to clearly discern the "plaques" or spots.

I am also impressed that you have obtained the strongest available form of the steroid and wonder - was this what the doctor advised, or was it something you specifically requested? If it was actually his advice, then I would have to say he is not as obdurate as one might assume from his advocacy of an inappropriately drastic approach.

Finally, as always, please tell how (and when?) you located this particular forum?

 
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George
(no login)

More of the story!

October 23 2006, 1:34 PM 

Hello Paul,

Thanks so much for your response, I’ve read a lot of your threads and learned so much. Right now I would be in real trouble without this list.

I read the first thread you indicate here and will keep that as my reference, it seems to have all the arguments against circ. I do find that the ‘alluded’ link doesn’t work for me but maybe that’s just my settings.

Yes I quickly came to the conclusion that what I have is LS and found out what cream I needed, I wouldn’t have gone to the doctor if I could have gotten it over the counter.

I wouldn’t say I’ve cured the condition, I still have a good bit to go but I have made significant progress, there is only one little bit of one of the white areas left and the tight band is still rough in areas. I have only been working at it for about 3 weeks.

Yes, I agree, my setback is a different problem and it has improved a bit, there is a bit more colour and the skin is not so spongy, seems much better after a hot bath. A couple of the areas I was treating have blistered a bit and I’m worried this will progress. My mind is all over the place which doesn’t help.

I have wondered about Thrush in general, some of the threads indicate that this can look like LS. Also my tongue is quite grey looking. Can I get the Creams/ Tablets you suggest over the counter? (must look in other threads again) I haven’t yet made an appointment with my doctor. If he doesn’t listen to my story he may just think the original condition is spreading. He phoned me up just before this happened asking if I needed to go ahead with a referral! Again he mentioned circ even though he openly says he isn’t an expert on this problem.

I am very analytical which is probably where a lot of the accuracy comes from, Also its only having read the threads that I discovered I’ve been overdosing on the cream. I was maybe putting on something like the volume of a couple of grains of rice twice a day. I did make sure the stuff was well rubbed in but it must have been transferring everywhere, the white patches having been treated were lying right on top of the Glans.

You are right regarding my application method, my finger has been the wrong applicator!

I was expecting 0.05% from what I had read but he automatically gave me the 0.1%, maybe just luck!

I did a Google search for Phmosis, these sites were high on the list, This forum is a link about 2/3 of the way down on the second site.

http://www.norm-uk.org/phimosis_clinical_guidelines.html
http://www.cirp.org/library/treatment/phimosis/

I just noticed that the first link is authored by Dr Peter Ball, perhaps the same as in your first thread. Bit odd that he suggests Circ on this list.

Sorry for the long story and thanks again for all the inputs.

George.

 
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Jim
(Login jimsplacetofixthings)
Forum Owner

Candida

October 23 2006, 2:21 PM 

Hi George,

Candida can be treated internally with a prescription from your doctor. Optionally or in addition, you may treat it with changes in diet. The yeast feeds on sugars, so if you eliminate or drastically reduce your intake of carbohydrates for a few weeks, you should get some results.

This means no dairy products, no beer, no wine, nothing which has been fermented such as vinegar, no bread. Get the idea?

While no dairy products is the rule, you could use yogurt with live cultures. This tends to get the stomach back in proper working order. Eat it plain or get acidopholis capsules. You may also apply some of the yogurt to the affected area. This is an old remedy that women have used for years before all of the glamor stuff we see advertised on TV.

Health food stores also have good remedies which will help to control the yeast.

Are you a sugar junkie, or have you had a regimen of antibiotics recently?

 
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George
(no login)

Candida

October 24 2006, 11:36 AM 

Hello Jim,

Thanks for the pointers. Looks like I will need to have a look at my diet to see what improvements I can make long term. I do need a quicker solution for my current problem though. I have been eating some bio yogurt after reading some of your other threads recently but that’s not going to help overnight.

I got some Daktarin Dual Action Cream today. I tried it this morning, but I’m nervous about putting anything in that area at the moment. I think I will try and get some tablets tomorrow, hopefully I can get them over the counter (that’s my next search tonight).

I cut out most sugar from my diet a few years ago and I haven’t been on any antibiotics at all, this recent visit to the Doctors was my first in probably 20 years.

George.

 
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Jim
(Login jimsplacetofixthings)
Forum Owner

Possibility of diabetes

October 24 2006, 4:00 PM 

While it's probably the intake of carbohydrates, there is also the very real possibility of adult onset diabetes. It might be wise to have that checked out.

 
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(Login Paul_B.)

Details ...

October 25 2006, 6:36 AM 

The link to "alluded" is correct, however was most certainly not for yourself or Peter, but just a dictionary for anyone else who might not be familiar with the word! I do that sometimes in case I am being a bit abstruse. I would have preferred to link to the exact entry, but unfortunately on this forum system, the individual entries are not tagged to facilitate this.

The similarity in appearance of "Thrush" - particularly the chronic forms - and LS is a point of some significance. There is some possibility that "Thrush" may be missed by a simple swab but still be present, and still be the base problem. As I have explained, even the biopsy process is not entirely reliable at determining the actual problem.

You do not however, have to have it (Thrush) all over; since you are only using the cream on your foreskin, it is most unlikely to encourage Thrush on your tongue or anywhere else, though diabetes which Jim mentions, might! The onset of any form of balanitis or as in your case, posthitis certainly mandates checking for diabetes (that is, with a blood test).

I should be a bit worried about a doctor who has such a fixation on circumcision, that he rings you at home to solicit you for the procedure!

I'm not at all sure I would say that your fingers are the wrong applicator - anything that gets the preparation onto the area with reasonable accuracy would seem to be OK.

Anyway, the antifungals I mention including the more expensive fluconazole (Diflucan®), are over-the-counter in most countries of which I am aware. Unless you happen to be allergic to one of them (and that is usually an allergy to one of the "excipients"), there should be no reason not to use them on your foreskin/ penis.

Thank you for citing the link by which you came here - I am most pleased to find CIRP using us as a reference/ resource, because that actually is more "targeted" than a "raw" Google search.

Before replying to his post, I made a point of approaching Dr. Peter Ball through NORM UK to determine firstly, that it was indeed he who had posted, and secondly, the import of his comment. It seems that he had not quite followed Kyle's description fully, particularly in regard of the duration of his foreskin tightness, and also has as it seems to me, not really examined the current medical understanding of Lichen Sclerosis, tending to regard it as a "lost cause" which is not worth defending as (not being) an "indication" for circumcision.

Having discussed this at various times with our local dermatologist and friendly urologist (in fact, I must say that all of our local urologists are particularly friendly ), I am fairly happy that I have presented the more up-to-date viewpoint - I'll see if Peter has any further observations and am quite happy or would prefer, to discuss the matter openly.

 
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George
(no login)

More

October 26 2006, 6:49 AM 

Hello Paul,

I miss-understood the part regarding your ‘alluded’ link, I thought it was a direct link to the particular paper you were talking about.

Regarding ‘Thrush’, I wasn’t thinking that the cream could cause that on my tongue. My tongue is just a bit yeasty and grey looking and has been for a while. My recent thinking (after having learnt a few things from you and Jim ) was that this is probably an indication of what’s going on elsewhere and so applying an immuno suppressant in a particular area could cause a reaction.

Im not overweight so I would hope Diabetes is not a contender at my age but I have ordered a blood test kit to check this out.

I got a Diflucan tablet yesterday so that should help things out.
I also got the Daktarin cream, the stuff for Athletes Foot – That’s OK Right?

As I said earlier I was wary about using this but I tried a spot this morning. Quite quickly the skin lost a lot of its structure and went all grey, its also quite sore. This resembles what happened last week. So I’m wondering if the issue really is Thrush or something else.
I tried some of the Daktarin on my arm at the same time – no reaction.

So, I’m stuck at the moment not being able to use either cream and I need to get back to the Steroid. Do you have any other thoughts on this? I am wary of seeing a Dermatologist or anyone else but maybe I need to in order to find out what’s going on with the creams. Betnovate was fine for weeks.

The Norm UK page appeared to have a positive view on treating LS conservatively so I was puzzled buy Peter’s response, more puzzled by your findings regarding his current medical understanding. Perhaps the paragraph in question is not the part he authored.

I have a few more questions but ill save them for now.

Thanks for all your inputs.

George.

 
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Jim
(Login jimsplacetofixthings)
Forum Owner

Ask away

October 26 2006, 9:59 AM 

Not all people with type 2 diabetes are necessarily overweight. One of my father's sisters was quite thin all of her life, and at about age 70 was diagnosed with the disease.

Have you tried your local health food store? I used a kit with several products that did the trick for me in about thirty days. Also remember that yogurt suggestion.

Treating the yeast aggressively may cause some reactions from all of the waste being dumped on your purification system to dispose of. Drink plenty of water to keep the kidneys flushed, and also ask the health food store about milk thistle to keep your liver healthy. Be sure to confer with your doctor about these ideas too. While milk thistle has no know side effects other than possible laxative effect, let him know anyway.

Here's a link to learn a little about it: http://www.rd.com/content/openContent.do?contentId=1546


 
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(Login Paul_B.)

Sensitivity.

October 26 2006, 1:53 PM 

I can't really see why you should react unfavourably to the Daktarin cream except that it might contain some excipient - or in fact the active agent - that may sting if the skin is already inflamed. Taking the Diflucan tablet would at least for the week, work to suppress any "Thrush" - except as always for the typical "exception" - there is a version of Candida called Candida Glabrata which may not respond to Diflucan, or may not responds as well as Candida Albicans.

I cannot by "remote control" assess your situation further - at least diagnostically. If you were to see a doctor about it, it would really need to be a dermatologist as your own doctor has expressed lack of expertise in this matter, and a urologist is even less likely to be interested in the treatment of skin conditions.

Given however that you have taken the Diflucan and the matter of Candida is most likely covered on that account (and that it should thereby be quite safe to use the steroid again), my suggestion for a soothing preparation if you need that on the irritated areas - and which can indeed be used on the whole of the glans and foreskin - is the standard Zinc and Castor Oil "Nappy" (American: diaper) cream - clearly extremely safe and in fact a mild deterrent in itself, to the Candida; also the cheapest and most easily available. It can be used as well as the steroid, but not necessarily at the same times.

"Ordered a blood test kit to check out" the glucose sounds interesting - the only form of blood test kit of which I was aware, is an electronic glucose meter such as diabetics use for routine monitoring, and which are relatively cheap nowadays - cheaper in fact than Blood Pressure monitors. The optical testing sticks for blood glucose would be cheaper, but appear to be almost if not completely obsolete.

 
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George
(no login)

More

October 29 2006, 11:03 AM 

I’m hoping now that the reaction was just because things haven’t completely settled down from my original setback. Also I didn’t react when I tried the Daktarin (although it did sting a bit) before I took the Diflucan tablet so there may be something in what Jim says.

Regarding my original setback, I read that the skin can become allergic to the steroid. Could this be likely when I was only using it for a relatively short period?

Anyway, I’ve been fairly comfortable the last couple of days since I haven’t applied anything so maybe I Just have to give it a bit time and monitor the LS. I will invest in some Nappy cream and maybe give the area a bit of air!

I wondered about the sequence of events that result in the tight ring, white because it tight I understand. Does this ring appear first followed by the crusty plaques or do the plaques result in the ring?

My frenulum is very white (tight) when I retract the skin and I wonder what’s coming next. Been reading more about LS and see it can affect the Glans and Urinary Tract in different ways.

Can you tell us a bit more about the kit you used Jim? I have seen some items like this but initially thought they might be more of a gimmick. I will try the acidopholis capsules you mention.

This is the Blood test kit I got, haven’t used it yet. Need to cut down the worry and get my appetite and bowel back in order first I suspect.

http://www.homehealth-uk.com/medical/diabetestest.htm#A

Thanks as always,

George.

 
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Jim
(Login jimsplacetofixthings)
Forum Owner

That was many years ago

October 29 2006, 11:36 AM 

However, I think the product was from Nature's Way. It included something called Capricin, Pau d'arco tea, some form of acidopholis and one or two additional products.

If you do a search for candida, you'll find a host of different solutions.

 
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