Treatments get a lot of discussion here at Lichen Sclerosus Support Network, at the doctor’s office, and in the scientific literature. And rightly so! Treatment is a very important topic. Often, discussions about treatment center around the proper application, side effects (risks versus benefits), and the science behind them. One thing that gets a lot less attention (and discussion) is expiry dates and lichen sclerosus medication. Expiry dates are important when using medications for lichen sclerosus, so today, we are going to chat about all things lichen sclerosus medication and expiry dates. Do expiry dates matter? Can you go past the expiry date? How to check your expiry date? These are all questions we will address in today’s post.
Our philosophy here at Lichen Sclerosus Support Network is always to present the evidence and/or what the experts are saying so you can make informed decisions about your body and healthcare plan.
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Lichen Sclerosus Treatments
The two main treatments for lichen sclerosus are topical corticosteroids (e.g., Clobetasol) and topical calcineurin inhibitors (e.g., Tacrolimus). Both of these are topical medications, meaning they are applied directly to the body. In the context of lichen scleorsus, they are applied to the genitals.
All medications, whether topical or oral (taken by mouth), have expiry dates. In the context of lichen sclerosus, you may wonder, “Should I be paying attention to the expiry date of my medication?” “How far past the expiry date can I use my medication?” and “Can I make my symptoms worse by using expired medication?”.
We are going to answer these questions both from a regular medication (i.e., commercially produced medication) and a compounded medication perspective.
Expiry Dates and Lichen Sclerosus Medication
Let’s start with commercially produced medications. Commercially produced medications are medications that are manufactured at scale and marketed to consumers and healthcare organizations. Commercially produced medications all have the same ingredients and formulations. This means if we both get a prescription for Clobetasol and fill it at a generic pharmacy, we have the exact same medication.
Can you use commercially produced steroids past their expiry date?
I chatted with a few pharmacists about this question, and they all agreed that while commercially produced steroids can be their expiration date, they want patients to know that their medication will start to lose potency over time.
This means that as the months go on, your steroid or calcineurin inhibitor will weaken. Essentially, your medication will have a harder time doing its job the more time lapses from the expiration date.
The Construction Worker Analogy
Think of it this way. A construction worker can do very good renovation work when they have all of the proper tools and equipment.
However, if someone steals the construction worker's tool kit, they will have difficulty completing the renovations.
It may take them longer to finish the renovations, and the final product may not be that great. Hinges may fall off the doors, there may be poor insulation, and the floors may be uneven.
Back to Expiry Dates and Lichen Sclerosus Medication
Now, let’s bring it back to your lichen sclerosus medication. Here at LSSN, we sometimes hear of people doing very well and all of a sudden finding their symptoms are coming back, or they are in a flare and start using their medication, but it doesn’t seem to work properly. They may think, “Oh no, steroids don’t work,” or “This must be a very bad flare,” or “Why am I getting worse even though I’m using my medication?”. I’ve heard quite a few stories where patients will tell their doctors this, and the doctors ask to see their tube of steroids or calcineurin inhibitors, only to discover the patient is using medication that has expired for months. Then, when the doctor informs them about the expired medication and the patient fills a new prescription, the patient starts to see results again.
Where Can I Find the Expiry Date of My Lichen Sclerosus Medication?
There is no one answer to this question. Where your expiry date is located will depend on the brand of medication you use and where in the world you live.
But, to give an example, let’s look at my tube of Clobetasol. I use the brand Taro and am located in Canada.
When I first filled out my prescription, my Clobetasol ointment came in a cardboard box. When the tube is still in its original box, the expiry date can be found on the small right-hand side (see image below). My current tube says EXP MA/2025, meaning my tube will expire in May 2025.
Then, when I remove the tube from its packaging, I can also find the expiry date directly on the tube, albeit it’s harder to see. On my tube, the expiry date is located at the base of the tube (opposite end of the cap) where the little fold is (see image below). Here as well, it says EXP MA/2025.
What If I Can’t Find the Expiry Date of My Lichen Sclerosus Medication?
Unfortunately, most companies do not take accessibility into consideration when putting expiry dates on medications. The print can be very small and challenging to see and read. If, for whatever reason, you are unable to see the expiration date, you can 1) ask a roommate, family member, partner, or friend if they can see it and tell you, or 2) you can call up your pharmacy and ask them when your prescription expires. You may want to get into the habit of asking your pharmacist to tell you the expiration date when you pick up your medication and then put that date in your phone as a reminder.
The Bottom Line
While using commercially produced medications for lichen sclerosus past the expiry date may not cause any harm or damage to the skin, it will lose effectiveness. After some time, you may notice you no longer get any benefit from using your medication. If you notice your medication does not seem to be helping and it is expired, you may want to call in a new prescription.
Compounded Medications and Expiry Dates
Now, remember how I explained commercially produced medications (i.e., they all have the same ingredients and formulations, and you can get them at any kind of pharmacy)? Well, another kind of medication is a compounded medication.
Compounded medications are tailor-made and individualized to the patient in question. You cannot fill a compounded medication prescription at a traditional pharmacy; you must go to a compounding pharmacy.
For example, when I was experiencing orofacial nerve pain, my pain specialist prescribed a unique, custom medication formula that I could not get a regular formula. My specialists added medications and specific doses based on my specific case instead of traditional pain medication.
Do You Need a Compounding Pharmacy with Lichen Sclerosus?
For the most part, no. Many people with LS are completely fine with commercially produced medications filled at a traditional pharmacy.
However, if you are allergic to (or have a sensitivity to) an ingredient in the base of your medication, you may benefit from having your medication compounded into an allergen-free base at a compounding pharmacy. Additionally, your doctor may prescribe a compounded medication for other reasons. For example, if you experience chronic yeast infections, your doctor may prescribe a compound that combines a steroid and an anti-fungal.
Therefore, if you think you are having a reaction to something in the base of your medication, talk with your doctor about this. They may issue allergy testing to determine what ingredient is the culprit and then prescribe a compounded formula that does not have that ingredient.
Compounding medications are often more expensive, so typically, doctors will avoid having to compound a prescription to save you money. There may be some cases where compounding your medications is cheaper, depending on where you live and your insurance.
If you think you need a compounded medication, be sure to have this conversation with your healthcare provider and call your insurance ahead of time to check for coverage.
Toronto-Based Compounding Pharmacy Shoutout
Just want to take a second here to shout out my compounding pharmacy in Toronto–Apotheca Compounding Pharmacy. Truly, the best team in Toronto. Their customer service, empathy, knowledge, compassion, and efficiency are next to none. If you need compounding in Toronto, be sure to give them a go!
Is it Safe to Use Expired Compounded Medication for Lichen Sclerosus?
Again, I consulted with a group of pharmacists on this one. If your medication is compounded, you do not want to use it past its expiration date. This is because compounding pharmacies have different guidelines to follow when creating your medication. You typically will not know the actual expiration date of the base ingredients. However, you will know the expiration date of the active medication + base ingredients. Compounded medications tend to expire significantly faster than regular medications. Further, when products are mixed, it can sometimes change the properties of the individual ingredients. The more ingredients used, the shorter the expiration may be. Therefore, you want to pay attention to the expiry date of your compounded medication.
Where to Find the Expiry Date on Compounded Medications?
This is going to depend on your pharmacy. When you pick up your medication, you may want to confirm with the pharmacist when it expires and note it down.
Conclusion on Expiry Dates and Lichen Sclerosus Medication
In sum, it is important to pay attention to expiration dates for lichen scleorsus medication. While it may not harm the skin per se, medications will start to lose potency, making them less effective in time. If you use compounded medications, the advice from pharmacists is to stop using them after they have expired and call in a new prescription. If the expiry date is unclear, ask a friend or family member if they can read it on your medication tube or call your pharmacist who dispensed the medication.
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