Balanitis xerotica obliterans

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Balanitis xerotica obliterans (BXO) is lichen sclerosus of the foreskin, a fibrotic condition of the foreskin first described by Stühmer[1],[2] in 1928

The aetiology is unclear. It can be considered the male foreskin equivalent of lichen sclerosus et atrophicus.[3] There is a small risk of dysplasia and progression to squamous cell carcinoma.

Contents

Clinical Features

  • Occurs later in life usually, but can occur in childhood
  • Foreskin is:
    • thickened
    • stenosed
    • sclerosed
    • depigmented
    • sometimes adherent to glans

Histological Features

  • Epidermal atrophy, but orthokeratotic hyperkeratosis
  • Expanded, hyalinised lamina propria
  • Vacuolar basal degeneration
  • Lichenoid band-like chronic inflammatory infiltrate

Treatment

Circumcision is the only effective treatment and is usually curative if the surgery is done before the condition spreads onto the glans or penile shaft skin.

Some have tried steroid creams but the evidence for this is weak and conflicting.

References

  1. Stühmer, A.: Balanitis xerotica obliterans (post-operationem) und ihre Beziehungen zur “Kraurosis glandis et praeputii penis,” Arch f. Dermat. u. Syph. 156:613, 1928.
  2. http://www.cirp.org/library/treatment/BXO/freeman1/
  3. ARCHIVES OF DERMATOLOGY AND SYPHILOLOGY, Volume 49: Page 57-59 http://www.cirp.org/library/treatment/BXO/laymon1/#n2

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