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In His Combo Regimen, Only Steroids Get Results
from Owen M.

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.

Eventually I went to the doctor who prescribed steroids and other dermatitis/eczema treatments, until, eventually a locum realised that it was P.

I was prescribed Dovonex cream and Dovonex scalp solution.  Scalp solution worked brilliantly, cream was useless.  I stopped using both.

When flaky 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 though.

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 every night.

Dovobet is 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.

*****

Ed’s 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. 

I understand 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 Dovonex Trial.) 

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.

If you’ve 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

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