[ ARC forum 2 ]
Written by Paul B. at 23 Apr 2003 00:26:15: Oops!
As an answer to: Re: Lichen Sclerosis written by Ivan at 22 Apr 2003 20:50:55:
Oh dear!
I fear you've missed the mark badly on this one, Ivan. Can I suggest you read carefully the link Chimp gave and digest it a little? (It does indeed contain errors, but is largely factual.)
The term "Lichen Sclerosis" is a very old one, used even before the concept of microbial infection was fully understood, and describes the appearance of the condition rather than its pathogenesis. This condition is generally understood to be auto-immune and not an infection, though in common with other such diseases, there is a possibility that it actually is caused by a pathogen. As the page mentions, a spirochaete such as causes Yaws and leprosy, not dissimilar in many ways, has been considered but is in no way adequately proven. It would however require very different antibiotics; the common ones would have no effect at all.
As a predominantly auto-immune condition, steroids remain the primary treatment, and must be the strongest available.
> Get to a better dermatologist.
The one thing about which I would be concerned, is that in this case, the steroids offered by the specialists have not been adequate (in strength/ type, precision of application, and/ or duration). There is some evidence from the posts on this board, that doctors either do not understand the nature and significance of various conditions, and offer completely inadequate steroid preparations because they have the notion (quite correct, but in this regard, quite inappropriate) that the strong ones are "dangerous", or the possibility must be considered in some cases, because they actually want the treatment to fail, to "prove" that circumcision is needed.
Now having said all that, in a diabetic, there is a very real possibility indeed of uncontrolled cutaneous candidiasis ("Thrush") causing the same appearance. This should have been excluded by ongoing treatment with either (daily) Ketoconazole or (weekly) Fluconazole for at least a month or preferably, two or more months. Of course, HIV would have been excluded.
And if a biopsy has not been taken and sent to a speciality dermatology histologist, then the specialists would indeed have been negligent.
The interesting thing about the site Chimp cites, and its one specific flaw, is the peculiar Americanism that presumes the foreskin immediately expendable, but states that the exact same therapy for women is the absolute last resort.