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In this month’s Journal of Urology, Tausch and Peterson report their findings regarding early aggressive treatment of Lichen Sclerosus. This is a disease of the penis that is also called balanitis xerotica obliterans (BXO). It is a benign condition that causes changes in the skin at the end of the penis that can move up the urethra and cause strictures that make it hard to urinate. It typically is found in uncircumcised older men. It is characterized by specific pathologic features and can return severely even if surgically corrected.
The authors studied 43 patients who had Lichen Sclerosis to some degree. Of these 40% got some combination of circumcision and clobetasol, a topical steroid. None of these patients had a recurrence. Another 28% had a resection of the urethra at the end of the penis, and these had no recurrence either. The other 33% had more invasive repairs and of these 50% had significant recurrences.
Obviously it is better to stop Lichen Sclerosis before it gets so bad serious surgery is required, and the patients that had progressive disease got the more invasive repairs with the associated high risk of recurrence. But it is important to see that clobetasol cream may on it’s own solve this problem for a significant number of men.
Some of the changes seen with this disease are also seen with penile cancer, and they can be confused in some cases. Many men wait months or years to have a problem like this looked at properly. Diagnosis requires an examination and often times a biopsy. If circumcision is done the biopsy is easily included.
A lot of men with this problem only come to light when they need a catheter in their bladder due to some unrelated health condition. Others come in with a poor stream, urinary blockage, and spraying of urine. If more men with this problem came in to discuss it before it became so bad, then perhaps severe cases could be avoided more often. If the penis is uncircumcised, and the foreskin is forming an ever-tighter ring over the penis with a white discoloration to the skin, consider having it evaluated before it becomes too much of a problem. Likewise if a circumcised penis is suffering from an ever smaller stream of urine or spraying.
The Journal of Urology, Vol. 187, 2101-2105, June 2012