First-Line Treatments: What Steroids Can (and Can’t) Do

If you’ve been diagnosed with Lichen Sclerosus by an NHS doctor, chances are you were prescribed a steroid cream — usually something like clobetasol propionate 0.05%. This is currently considered the gold-standard treatment for LS across the UK and much of the world.

But what do these creams actually do? How should they be used? And why do they work for some people, but not for others?

Let’s break it down.

How Topical Steroids Work

Topical corticosteroids reduce inflammation in the skin. In the context of LS, they help:

• Calm down the immune system’s overreaction
• Reduce redness, itching, and soreness
• Prevent further skin thinning, scarring or architectural change
• Lower the risk of skin cancer in the vulval area, which is slightly higher in long-term untreated LS

When used properly, steroids can dramatically improve symptoms and halt disease progression.

Common Steroids Used for LS

• Clobetasol propionate 0.05% – a very potent steroid, used as first-line treatment
• Mometasone furoate or betamethasone valerate – sometimes used for maintenance after symptoms are controlled

You may be given an ointment (greasier, more hydrating) or a cream (easier to apply, but may be more irritating).

How to Apply Topical Steroids Correctly

Many people are scared of steroid creams. And it’s true that overuse can thin the skin. But underuse — or using it incorrectly — is often the bigger problem with LS.

Here’s how to use them safely:

• Start with daily use: Apply once a day (usually at night) for 4–6 weeks, or as prescribed.
• Use a fingertip unit: One fingertip’s worth of ointment should cover the entire vulval area.
• Apply to clean, dry skin: Use after washing with water or a gentle, fragrance-free cleanser.
• Massage in gently: Don’t rub aggressively.
• Tailor your use: Once symptoms settle, reduce to alternate days or twice a week for maintenance.

If your doctor hasn’t shown you how to apply it — ask. Or find a vulval specialist who can guide you.

What Steroids Can’t Do

While steroids can be life-changing, they aren’t a cure. They don’t:

• Reverse skin scarring or architectural change
• Restore lost elasticity or sensation
• Address hormonal imbalance
• Heal emotional trauma or sexual pain

Some people also find that steroids irritate their skin or simply don’t work well enough. In those cases, alternatives or additional therapies are needed.

Side Effects to Watch For

When used correctly, side effects are rare. But long-term misuse or overuse can cause:

• Skin thinning (atrophy)
• Stretch marks
• Secondary infections (e.g. thrush)
• Irritation or stinging

Always check in with your doctor if you’re unsure — especially if symptoms worsen or change.

What to Do If Steroids Aren’t Enough

If you’re still experiencing discomfort, or if your symptoms come back quickly after stopping treatment, don’t panic. This doesn’t mean you’re beyond help — it means your treatment plan may need adjusting.

Many people benefit from combining steroid treatment with:

• Hormonal therapy (e.g. vaginal oestrogen)
• Advanced treatments like the O Shot® or Morpheus8V
• Pelvic floor therapy or counselling for sexual pain

We’ll explore all these options in the chapters ahead.

For now, know this: topical steroids are not your enemy. When used properly, they’re one of the most effective tools we have for controlling LS and protecting your skin.

In the next chapter, we’ll look at what happens when steroids alone aren’t enough — and what other options might help you feel like yourself again.

Chapter 14: Beyond Steroids – Advanced and Holistic Options for LS