The response of clinical balanitis xerotica obliterans to the application of topical steroid-based creams

      Abstract

      Objective

      The aim of this study was to assess the effectiveness of using topical steroid-based creams in the management of clinically diagnosed balanitis xerotica obliterans (BXO) in boys.

      Methods

      The response in 56 boys to locally applied steroid-based creams was studied retrospectively. All had been referred by their general practitioners with symptoms of penile pathology and then subsequently had a clinical diagnosis of BXO made. The boys were initially assessed after 3 months of treatment and then at various intervals depending on their response.

      Results

      The mean age at presentation of the boys was 8.9 (4 to 15) years. After the initial 3-month assessment, 10 (17.9%) boys had complete resolution. When the treatment period was prolonged by an average of 14 months, the total number of boys showing resolution increased to 17 (30.4%). All boys showing resolution had clinically mild BXO limited to the prepuce only. Those patients with established scar formation on the foreskin showed no significant improvement.

      Conclusions

      Topical steroids seem to offer a reliable option only in the management of mild BXO limited to the prepuce in boys with minimal scar formation. Steroid-based creams can be offered to such patients provided they and their families are realistic as to the likelihood of success. This treatment is ineffective in the face of established scarring.

      Index words

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      References

      1. Awakenings: a preliminary poll of circumcised men. Spring 1994, revised 1997. Full report available from NOHARMM, PO Box 460795, San Francisco, CA 94146.

      2. NORM UK. PO Box 71, Stone, Staffordshire, England, ST15 0SF.

        • Cold C.J.
        • Taylor J.R.
        The prepuce.
        Br. J. Urol. 1999; 83: 34-44
        • Rickwood A.M.K.
        • Kenny S.E.
        • Donnell S.C.
        Towards evidence based circumcision of English boys: survey of trends in practice.
        BMJ. 2000; 321: 792-793
        • Bale P.M.
        • Lockhead A.
        • Martin H.C.
        • et al.
        Balanitis xerotica obliterans in children.
        Pediatr. Pathol. 1987; 7: 617-627
        • Hrebinko R.L.
        Circumferential laser vaporization for severe meatal stenosis secondary to balanitis xerotica obliterans.
        J. Urol. 1996; 156: 1735-1736
        • Poynter J.H.
        • Levy J.
        Balanitis xerotica obliterans: effective treatment with topical and sublesional corticosteroids.
        Br. J. Urol. 1967; 39: 420-425
        • Catterall R.D.
        • Oats J.K.
        Treatment of balanitis xerotica obliterans with hydrocortisone injections.
        Br. J. Vener. Dis. 1962; 38: 75-77
        • Pasieczny T.A.H.
        The treatment of balanitis xerotica obliterans with testosterone propionate ointment.
        Acta Derm. Venerol. (Stockholm). 1977; 57: 275-277
        • Shelley W.B.
        • Shelley E.D.
        • Grunenwald M.A.
        • et al.
        Long term antibiotic therapy for balanitis xerotica obliterans.
        J. Am. Acad. Dermatol. 1999; 40: 69-72
        • Wright J.E.
        The treatment of childhood phimosis with topical steroid.
        Aust. N. Z. J. Surg. 1994; 64: 327-328
        • Kikiros C.S.
        • Beasley S.W.
        • Woodward A.A.
        The response of phimosis to local steroid application.
        Pediatr. Surg. Int. 1993; 8: 329-332
        • Jorgensen E.T.
        • Svensson A.
        The treatment of phimosis in boys with a potent topical steroid (clobetasol propionate 0.05%) cream.
        Acta Derm. Venereol. (Stockholm). 1993; 73: 55-56
        • Meuli M.
        • Briner J.
        • Hanimann B.
        • et al.
        Lichen sclerosis et atrophicus causing phimosis in boys: a prospective study with 5-year follow up after complete circumcision.
        J. Urol. 1994; 152: 987-989
        • Garat J.M.
        • Chechile G.
        • Algaba F.
        • et al.
        Balanitis xerotica obliterans in children.
        J. Urol. 1986; 137: 436-437
        • Weitzner S.
        • Albuquerque N.M.
        Posthitis xerotica obliterans in a 12-year old boy.
        Amer. J. Dis. Child. 1972; 123: 68-69
        • Gairdner D.
        The fate of the foreskin—a study of circumcision.
        BMJ. 1949; 2: 1433-1437
        • Spence J.
        Spence on circumcision.
        Lancet. 1964; 2 (special article): 902