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His Combo Regimen, Only Steroids Get Results
I have only
been suffering from P for 3 years, originally started after strep
infection and showed itself as a penny-sized red patch on my face.
This disappeared after 3 months and I was clear for about 6 months.
I then started noticing that I was flaking from my scalp.
This did not get any better for using dandruff shampoo etc.
Then my face patch returned.
After 12 months
of flaky scalp and small face patch, I made the mistake of providing a
home to two kittens. Wherever
they scratched, I get a lesion.
went to the doctor who prescribed steroids and other dermatitis/eczema
treatments, until, eventually a locum realised that it was P.
prescribed Dovonex cream and Dovonex scalp solution.
Scalp solution worked brilliantly, cream was useless.
I stopped using both.
scalp reappeared ( after 2 weeks of not using) I went back to the scalp
solution. This time it did not
touch it, just got worse and worse.
I have finally
been returned to a specialist who prescribed Dovobet.
Absolutely fantastic, lesions stopped flaking and smoothed over
within 2 days. No itching
whatsoever. For the scalp I
was given cocois oil and coal tar shampoo.
Again fantastic, within two days no flaking, still slightly itchy
Anyway after a
long story, I was told to return to Dovonex after 2 weeks which I did.
It all got worse again. I
have now been using a combination of Dovobet twice a week, with Dovonex
the rest, but nothing is getting better.
I will be going back onto Dovobet full time if I have my way.
Also I'm only
supposed to use cocois for 2 hours twice a week, but I have to use it
fantastic stuff but I can't come off it if I want results.
Any chance of a Dovobet scalp solution?
Regards, Keep up the good work, -Owen M.
Response: Your response
isn’t uncommon, Owen. Your
derm wants you to respond well to the vitamin D derivative calcipotriol,
which is safe to use long term, and not become dependent upon a potent
topical corticosteroid like betamethasone
dipropionate, which shouldn’t be used long term.
Dovobet is a combination of both the vitamin D derivative and the
corticosteroid. (Here in the
U.S. the same treatment is achieved routinely by prescribing a combination
of Dovonex — the calcipotriol — and a formulation like Diprolene —
the betamethasone dipropionate.)
One of the
oft-reported reactions to the vitamin D derivative calcipotriol is that it
takes longer to achieve lesion improvement than is the case with the
corticosteroids. A typical
course for someone who responds well to calcipotriol would be the one you
are on followed by a “phased in” version of the calcipotriol minus the
corticosteroid. One of the
problems associated with this best intention is flare-ups when the
corticosteroid dose is diminished or eliminated.
that many patients discontinue using Dovonex (a pure version of
calcipotriol; that is, not combined with
a corticosteroid) too early to know if it would eventually control their
lesions. I suspect this is
what I did. (See Ed’s
The cocois oil
(salicylic acid) and coal tar shampoo for the scalp is one of the oldest
treatments still common for P. The
use of topical corticosteroids on the scalp is often discouraged because
the skin is thin and the undesirable chance of absorbing the steroid into
the bloodstream is increased. There
are, however, a number of steroid formulations just for the scalp, which
is to say they are mild and in bases (usually liquid solutions or foam)
that easily penetrate the hair.
given calcipotriol — without a steroid booster — enough time to
demonstrate its maximum effectiveness for you, and this is insufficient,
you might talk to your specialist about alternative therapies.
Ask him if you might be reacting so well to the steroids in your
medication (Dovobet) that when you stop using them flare-ups overwhelm the
vitamin D-derivative replacement medication.
Also, if the salicylic acid/coal tar derivative scalp treatment
stops working, ask your specialist about corticosteroid formulations
designed expressly for use on the scalp.
It appears to me that you have many treatment alternatives remaining to try. -Ed