Reactions Weekly | 2021
Clobetasol/prednisone
Abstract
Lack of efficacy: case report A 13-year-old girl exhibited lack of efficacy during treatment with prednisone for acute genital ulcers and clobetasol for labial adhesion. The girl presented to emergency department with severe ulceration and oedema of the vulva. She was not sexually active and not menstruating at the time of the symptoms. She also had symptoms of COVID-19, for which she tested positive. She had a history of a minor deletion of the SHOX gene and recurrent oral aphthae. She had been receiving somatropin [human growth hormone]. Her sister had a history of Lipschutz ulcers from Epstein-Barr virus. Upon extensive examination, diagnosis of acute genital ulcers related to COVID-19 was considered in the absence of any other aetiology. Initially, an unspecified steroid cream and lidocaine were prescribed. However, she could not use the steroid cream due to extreme pain. Therefore, she started receiving oral prednisone 45mg daily for 4 days, 40mg daily for 4 days, 20mg daily for 4 days and then 10mg daily for 2 days. Six days following the initial vulvar symptoms, she developed severe dysuria. Phenazopyridine [pyridium] was started. On day 7, she presented again to hospital for pain management and oral steroids. She was admitted for 5 days to control pain. She completed the 14-day course of prednisone. She received lidocaine and benzocaine for pain control. The genital oedema decreased. However, ulcers and vulvar pain persisted. Therefore, lack of efficacy was considered for prednisone. The girl’s treatment was started with colchicine. Within 1 week, further improvement in oedema and pain was noted. Rheumatological examination excluded Behcet’s syndrome. Within six weeks, the oedema and ulceration resolved. However, agglutination of the labia minora was noted. A topical clobetasol [clobetasol propionate] 0.05% ointment was prescribed for labial adhesion. However, the adhesion was refractory to the treatment (lack of efficacy). Subsequently, lysis of labial adhesions was performed under sedation. Postoperative evaluation showed normal anatomy without evidence of scarring. The pain had resolved.