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Penile Lichen Sclerosus
Aka: Penile Lichen Sclerosus, Balanitis Xerotica Obliterans
- See Also
- Lichen Sclerosus
- Vulvar Lichen Sclerosus
- Penile Lesion
- Definition
- Idiopathic (possibly autoimmune), chronic inflammatory condition of peri-mucosal skin
- Typically vulvar involvement in women is more common
- Epidemiology
- Average age of onset 42 years
- Prevalence: One in 300 males
- Symptoms
- Asymptomatic in one third of patients
- Pruritic foreskin
- May bleed
- May be severe enough to interfere with sleep
- Dysuria
- Urinary obstruction (long-standing cases)
- Painful Erections
- Painful Defecation (if Anal Fissures present)
- Signs
- Initial
- Glans and foreskin is thick and white
- Contiguous edema may be present
- Later
- Foreskin in thin, Wrinkled and hypopigmented (like cellophane)
- Bruising may be present
- Last
- Foreskin and contiguous anatomy distorted
- May obscure surrounding antomy
- Phimosis may occur in men (may result in obstructive uropathy)
- Labs: Biopsy
- Biopsy especially indicated if squamous cell hyperplasia present
- Risk of developing Squamous Cell Carcinoma of the foreskin is 4-6% in Lichen Sclerosus
- Biopsy foreskin lesions that fail to heal with management (see below)
- Differential Diagnosis
- Penile Squamous Cell Cancer in-situ
- Penile Squamous Cell Cancer
- Scleroderma
- Associated Conditions: Autoimmune Conditions (present in >20% of cases)
- Alopecia Areata
- Vitiligo
- Hypothyroidism or Hyperthyroidism
- Pernicious Anemia
- Management (much of the supporting research was done in women with Vulvar Lichen Sclerosus)
- Topical Corticosteroids
- Initial (first 2-3 months until active inflammation has resolved)
- Level 1 High potency Corticosteroid (e.g. Temovate 0.05% ointment) applied daily
- Lorenz (1998) J Reprod Med 43:790-4 [PubMed]
- Later (maintenance)
- Taper high potency steroid to 1-2 times weekly or
- Level 5 Medium potency steroid (e.g. Valisone 0.1% cream) applied daily
- Clinic procedures for thickened lesions
- Intralesional Corticosteroid Injection (up to 10-20 mg of triamcinoline acetonide)
- Mazdisnian (1999) J Reprod Med 44:332-4 [PubMed]
- Cryotherapy (one freeze per lesion)
- Other topical management
- Tacrolimus or Pimecrolimus
- Tretinoin (e.g. Retin-A) applied topically to lesions
- Bracco (1993) J Reprod Med 38:37-40 [PubMed]
- Hormonal creams (Progesterone or Testosterone) are not effective
- Sideri (1994) Int J Gynaecol Obstet 46:53-6 [PubMed]
- Other systemic medications (severe refractory cases)
- Systemic Retinoids
- Methotrexate
- Surgical management
- Circumcision (if not already circumsized)
- Reconstructive surgery (severe cases)
- Complications
- Penile squamous cell cancer
- Genital Lichen Sclerosus is considered premalignant (4-6% squamous cell cancer Incidence)
- Phimosis
- Painful Erection
- Urinary obstruction
- References
- Funaro (2004) Dermatol Ther 17(1): 28-37 [PubMed]
- Meffert (1995) J Am Acad Dermatol 32:393-416 [PubMed]
- O'Connell (2008) Am Fam Physician 77:321-30 [PubMed]
- Teichman (2010) Am Fam Physician 81(2): 167-74 [PubMed]
- Teichman (2018) Am Fam Physician 97(2): 102-10 [PubMed]