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Did Dovobet on Clear Skin Cause New Lesions?
from Bobby D.

Hi Ed:  Just a note in response to The Truth About Dovobet.  I suffer from P on elbows, knees and ankles and occasionally on my nose!  My Doctor prescribed Dovobet (grossly overpriced in Ireland @ EUR106).

Fairly immediate improvement was followed by a drop in efficacy.  More recently I have noticed P spreading down my forearms where I never had it before, but would well have had some Dovobet applied (overspill from other patchy areas).  Clearly not a magic bullet and worth pointing out to other readers.

I've ditched Dovobet till after the Summer when I hope my skin will improve naturally and the efficacy of the drug will return.  –Bobby D.


Ed’s Response:  Dovobet is a combination drug.  It’s active ingredients are Calcipotriene (calcipotriol in the U.K., a form of vitamin D), also available in the U.S. as Dovonex, and betamethasone dipropionate (a corticosteroid), available in the U.S. both generically and as Diprolene.  Before Dovobet became available in the U.K., many derms were prescribing combination regimens of calcipotriene and betamethasone dipropionate.  (Also see Dovobet Helping in a Hurry.)

Interestingly, and perhaps anecdotally, both these drugs can aggravate clear skin, in which case a P lesion can be ignited either as a direct effect of the drug or through the Koebner phenomenon (which is generation of a lesion through general trauma to the skin).  This is why the manufacturers of both and the combination product, Dovobet, caution against letting the medicine overlap onto clear skin when it is applied to a lesion.  (Even if a P lesion does not result, we are cautioned that the action of these compounds on clear skin should be avoided.)

For some of us this doesn’t seem to be a significant problem.  For others, it can be.  Frankly, unless I had a nurse doing the applying, and had plenty of time to let it be absorbed into lesions before getting dressed and moving around, I don’t know how getting my meds on clear skin could be entirely avoided.  When I’m flaming and depending on topicals to bring it all under control, I slather it on with little attempt to keep it off the sometimes minor patches of clear skin between the lesions on my extremities.

My own experience with Dovonex (April-May, 1998) ended with my concluding this topical was not worth its cost in U.S. dollars.  It was twice as expensive as my corticosteroid topicals and, overall, less effective.  In this I don’t think my experience was unique.  The combination product, Dovobet, is intended to bring flaker’s the best of both approaches, topical Vitamin D and steroid.  But, as I have since learned, my use of topicals at all is, at best, a stop gap.  My P is too recalcitrant to be treated effectively, and for long periods, by topicals alone.  -Ed

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