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| __NOTOC__
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| {{CMG}}{{AE}}{{VD}}
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| {{SK}}BXO, Penile lichen sclerosus
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| ==Overview==
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| Balanitis xerotica obliterans (BXO) is a dermatological (skin) condition affecting the male genitalia. It was first described by Stuhmer in 1928, though earlier reports describe what may have been the same condition.[1] BXO commonly occurs on the foreskin and glans penis.[2] Atrophic white patches appear on the affected area,[3] and commonly, a whitish ring of indurated (hardened) tissue usually forms near the tip that may prevent retraction.[2]
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| ==Historical Perspective==
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| ==Classification==
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| There is no established classification system for BXO.
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| ==Pathophysiology==
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| The exact etiology of BXO is unknown, but multiple factors are considered to play an important in the development of BXO.
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| {| class="wikitable"
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| ! colspan="3" |Factors associated with pathogenesis of BXO
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| |Uncircumcised Penis
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| | colspan="2" |Accumulation of secretions and epithelial debris between the foreskin and coronal sulcus leads to chronic irritation, sublincal trauma. <ref name="pmid8491994">{{cite journal| author=Schempp C, Bocklage H, Lange R, Kölmel HW, Orfanos CE, Gollnick H| title=Further evidence for Borrelia burgdorferi infection in morphea and lichen sclerosus et atrophicus confirmed by DNA amplification. | journal=J Invest Dermatol | year= 1993 | volume= 100 | issue= 5 | pages= 717-20 | pmid=8491994 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8491994 }}</ref>
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| |Autoimmune diseases
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| | colspan="2" |Patients with BXO, were found to have an other associated autoimmune conditions, which include: diabetes mellitus, vitiligo, alopecia aerata.<ref name="pmid78687092">{{cite journal| author=Meffert JJ, Davis BM, Grimwood RE| title=Lichen sclerosus. | journal=J Am Acad Dermatol | year= 1995 | volume= 32 | issue= 3 | pages= 393-416; quiz 417-8 | pmid=7868709 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7868709 }}</ref>
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| Some studies have showned association between BXO and HLA DQ7 with DR11 and DR12.<ref name="pmid10215772">{{cite journal| author=Azurdia RM, Luzzi GA, Byren I, Welsh K, Wojnarowska F, Marren P et al.| title=Lichen sclerosus in adult men: a study of HLA associations and susceptibility to autoimmune disease. | journal=Br J Dermatol | year= 1999 | volume= 140 | issue= 1 | pages= 79-83 | pmid=10215772 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10215772 }}</ref>
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| | rowspan="2" |Infections
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| |Human papillomavirus (HPV)
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| |Several studies have implicated human papillomavirus as a causative agent in pathogenesis of BXO. HPV 16, 18, 33 and 51 have been found to associated with BXO.
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| Recent studies reported lack of clincal correlation of BXO and HPV, has they both have unrelated transcriptosome.
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| | colspan="2" |Several studies have reported association of various infectious organisms with development of Balanitis xerotica obliterans, which include:
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| * Borrelia burgdoferi<ref name="pmid9006371">{{cite journal| author=Fujiwara H, Fujiwara K, Hashimoto K, Mehregan AH, Schaumburg-Lever G, Lange R et al.| title=Detection of Borrelia burgdorferi DNA (B garinii or B afzelii) in morphea and lichen sclerosus et atrophicus tissues of German and Japanese but not of US patients. | journal=Arch Dermatol | year= 1997 | volume= 133 | issue= 1 | pages= 41-4 | pmid=9006371 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9006371 }}</ref>
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| * HCV<ref name="pmid9349358">{{cite journal| author=Boulinguez S, Bernard P, Lacour JP, Nicot T, Bedane C, Ortonne JP et al.| title=Bullous lichen sclerosus with chronic hepatitis C virus infection. | journal=Br J Dermatol | year= 1997 | volume= 137 | issue= 3 | pages= 474-5 | pmid=9349358 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9349358 }}</ref>
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| * Epstein-Barr virus<ref name="pmid20885159">{{cite journal| author=Aidé S, Lattario FR, Almeida G, do Val IC, da Costa Carvalho M| title=Epstein-Barr virus and human papillomavirus infection in vulvar lichen sclerosus. | journal=J Low Genit Tract Dis | year= 2010 | volume= 14 | issue= 4 | pages= 319-22 | pmid=20885159 | doi=10.1097/LGT.0b013e3181d734f1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20885159 }}</ref>
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| |Genetics
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| | colspan="2" |Several studies have proposed genetic association and lichen sclerosis.
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| In females, 12% of patients were found to have a family history of lichen sclerosis,.
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| In males, there is no evidence familial predisposition.
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| | colspan="2" |Environmental factors
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| BXO is known to demonstrate koebner phenomenon.<ref name="pmid20973765" />
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| Trauma, old scars, skin grafts, sunburn and radiation were found to be associated with BXO.<ref name="pmid20973765">{{cite journal| author=Bjekić M, Šipetić S, Marinković J| title=Risk factors for genital lichen sclerosus in men. | journal=Br J Dermatol | year= 2011 | volume= 164 | issue= 2 | pages= 325-9 | pmid=20973765 | doi=10.1111/j.1365-2133.2010.10091.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20973765 }}</ref>
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| Some studies have proposed that post-micturation dribbling or microincontinence plays a central role in development of BXO.<ref name="pmid17854373">{{cite journal| author=Bunker CB| title=Male genital lichen sclerosus and tacrolimus. | journal=Br J Dermatol | year= 2007 | volume= 157 | issue= 5 | pages= 1079-80 | pmid=17854373 | doi=10.1111/j.1365-2133.2007.08179.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17854373 }}</ref>
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| |}
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|
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| === Histopathology ===
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| Histopatholgy findings found in BXO include:<ref name="pmid22085120">{{cite journal| author=Clouston D, Hall A, Lawrentschuk N| title=Penile lichen sclerosus (balanitis xerotica obliterans). | journal=BJU Int | year= 2011 | volume= 108 Suppl 2 | issue= | pages= 14-9 | pmid=22085120 | doi=10.1111/j.1464-410X.2011.10699.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22085120 }}</ref>
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|
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| ==== Early stage of BXO ====
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| * Moderately heavy lymphocytic infiltrate in found in basal epidermis and superficial dermis in early stages of the lesion.
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|
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| ==== Late stages of BXO ====
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| * Epidermis becomes atrophic with surface hyperkeratosis, thickened basement membrane
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| * Broad zone of subepidermal oedema with homogenization of collagen, which becomes more sclerotic over time.
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| * In few cases, epidermis is detached from dermis resulting in formation of haemorrhagic bullae.
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| * <section></section>
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| ==Causes==
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| The etiology of BXO is uncertain. However, some possibilities have been suggested:
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| {| class="wikitable"
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| ! colspan="4" |Causes of BXO
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| |Uncircumcised Penis
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| ==Epidemiology and Demographics==
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| The true [[prevalence]] of BXO is controversial and unclear. One study calculated a rate of 0.6% of boys affected by their 15th birthday.<!--
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| --><ref name="shankar19992">{{cite journal | author = Shankar K, Rickwood A | title = The incidence of phimosis in boys. | journal = BJU Int | volume = 84 | issue = 1 | pages = 101-2 | year = 1999 | month = Jul | id = PMID 10444134}}</ref> Another reported a rate of 0.07%.<!--
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| --><ref name="kizer20032">{{cite journal | author = Kizer W, Prarie T, Morey A | title = Balanitis xerotica obliterans: epidemiologic distribution in an equal access health care system. | journal = South Med J | volume = 96 | issue = 1 | pages = 9-11 | year = 2003 | month = Jan | id = PMID 12602705}}</ref> However, a review noted that "with a high degree of suspicion and [[Histology|histologic]] examination, the condition will prove to be much more frequent than one generally believes."<!--
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| --><ref name="das20002">{{cite journal | author = Das S, Tunuguntla H | title = Balanitis xerotica obliterans--a review. | journal = World J Urol | volume = 18 | issue = 6 | pages = 382-7 | year = 2000 | month = Dec | id = PMID 11204255}}</ref> Another suggested that "more cases would be [[Diagnosis|diagnosed]] during infancy if all dried foreskin were examined systematically."<!--
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| --><ref name="garat19862">{{cite journal | author = Garat J, Chéchile G, Algaba F, Santaularia J | title = Balanitis xerotica obliterans in children. | journal = J Urol | volume = 136 | issue = 2 | pages = 436-7 | year = 1986 | month = Aug | id = PMID 3735511}}</ref> Another remarked that the condition "may be misdiagnosed or ignored in the young boy."<!--
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| --><ref name="mckay19752">{{cite journal | author = McKay D, Fuqua F, Weinberg A | title = Balanitis xerotica obliterans in children. | journal = J Urol | volume = 114 | issue = 5 | pages = 773-5 | year = 1975 | month = Nov | id = PMID 1237636}}</ref> Yet another commented that "its true incidence is not appreciated because most cases are cured by [[circumcision]], and unfortunately many surgeons still fail to send their circumcision specimens for histology."<!--
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| --><ref name="depasquale20002">{{cite journal | author=Depasquale I, Park AJ, Bracka A. | title=The treatment of balanitis xerotica obliterans | journal=BJU Int | year=2000 | month= | volume=86 | issue=4 | pages=459-65 | id= | url=http://www.cirp.org/library/treatment/BXO/depasquale1/ | format=Reprint:The CIRP Circumcision Reference Library | accessdate=2006-10-01 }}</ref> Another remarked that the "extent of [[asymptomatic]] disease in this series would suggest the true prevalence of LS in men might be much higher than published work suggests."<!--
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| --><ref name="riddell20002">{{cite journal | author=Riddell I, Edwards A, Sherrard J. | title=Clinical features of lichen sclerosus in men attending a department of genitourinary medicine | journal=Sex Trans Infect | year=2000 | month=Aug | volume=76 | issue=4 | pages=311-3 | id= | url=http://sextrans.bmjjournals.com/cgi/content/full/76/4/311}}</ref>
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| According to some authors, the disease most frequently affects middle-aged men. However, a large study reported that the age distribution was similar from 2 to 90 years of age, except for men in their twenties, who were at twice the risk.<ref name="kizer20032" /> The same study found that [[Black people|black]] and [[Hispanic]] men had approximately twice the risk of white men. The authors suggested possible reasons for this, including access to health care, differences in neonatal circumcision rates, and climate differences.
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| Mallon ''et al.'' found that BXO was related to circumcision status. Adjusting for age, lack of circumcision was associated with an [[odds ratio]] of 53.55. The finding was [[Statistical significance|statistically significant]].<ref name="mallon20002">{{cite journal | author = Mallon E, Hawkins D, Dinneen M, Francics N, Fearfield L, Newson R, Bunker C | title = Circumcision and genital dermatoses. | journal = Arch Dermatol | volume = 136 | issue = 3 | pages = 350-4 | year = 2000 | month = Mar | id = PMID 10724196}}</ref> However, BXO has also been noted to occur after late circumcision, especially when performed for [[phimosis]].<ref name="mallon20002" /><ref name="kizer20032" />
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| ==Screening==
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| There is no established screening guidelines for BXO.
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| ==Natural History, Complications, and Prognosis==
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| ===Natural history===
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| If left untreated, BXO involve the penile skin, scrotum, and entire urethra leading to the complications.<ref name="pmid10971272">{{cite journal| author=Depasquale I, Park AJ, Bracka A| title=The treatment of balanitis xerotica obliterans. | journal=BJU Int | year= 2000 | volume= 86 | issue= 4 | pages= 459-65 | pmid=10971272 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10971272 }}</ref>
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|
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| ===Complications===
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| Complication of BXO include the following:<ref name="pmid20854400">{{cite journal| author=Neill SM, Lewis FM, Tatnall FM, Cox NH, British Association of Dermatologists| title=British Association of Dermatologists' guidelines for the management of lichen sclerosus 2010. | journal=Br J Dermatol | year= 2010 | volume= 163 | issue= 4 | pages= 672-82 | pmid=20854400 | doi=10.1111/j.1365-2133.2010.09997.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20854400 }} </ref><ref name="pmid10570372">{{cite journal| author=Nasca MR, Innocenzi D, Micali G| title=Penile cancer among patients with genital lichen sclerosus. | journal=J Am Acad Dermatol | year= 1999 | volume= 41 | issue= 6 | pages= 911-4 | pmid=10570372 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10570372 }} </ref><ref name="pmid14576478">{{cite journal| author=Velazquez EF, Cubilla AL| title=Lichen sclerosus in 68 patients with squamous cell carcinoma of the penis: frequent atypias and correlation with special carcinoma variants suggests a precancerous role. | journal=Am J Surg Pathol | year= 2003 | volume= 27 | issue= 11 | pages= 1448-53 | pmid=14576478 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14576478 }} </ref><ref name="pmid18047520">{{cite journal| author=Prowse DM, Ktori EN, Chandrasekaran D, Prapa A, Baithun S| title=Human papillomavirus-associated increase in p16INK4A expression in penile lichen sclerosus and squamous cell carcinoma. | journal=Br J Dermatol | year= 2008 | volume= 158 | issue= 2 | pages= 261-5 | pmid=18047520 | doi=10.1111/j.1365-2133.2007.08305.x | pmc=2268980 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18047520 }} </ref><ref name="pmid12786863">{{cite journal| author=Thami GP, Kaur S| title=Genital lichen sclerosus, squamous cell carcinoma and circumcision. | journal=Br J Dermatol | year= 2003 | volume= 148 | issue= 5 | pages= 1083-4 | pmid=12786863 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12786863 }} </ref><ref name="pmid19126024">{{cite journal| author=Ranjan N, Singh SK| title=Malignant transformation of penile lichen sclerosus: exactly how common is it? | journal=Int J Dermatol | year= 2008 | volume= 47 | issue= 12 | pages= 1308-9 | pmid=19126024 | doi=10.1111/j.1365-4632.2008.03866.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19126024 }} </ref>
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| * Phimosis
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| * Painful erection
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| * Reduced urinary flow
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| * Urinary retention
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| * Risk of malignant transformation into Squamous cell carcinoma(Long-term prospective studies are needed to determine the real risk of malignant transformation)
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|
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| ===Prognosis===
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|
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| Prognosis is good with treatment.<ref name="pmid220851205">{{cite journal| author=Clouston D, Hall A, Lawrentschuk N| title=Penile lichen sclerosus (balanitis xerotica obliterans). | journal=BJU Int | year= 2011 | volume= 108 Suppl 2 | issue= | pages= 14-9 | pmid=22085120 | doi=10.1111/j.1464-410X.2011.10699.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22085120 }}</ref>
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| ==Diagnosis==
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|
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| ===History and symptoms===
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| Patients with BXO could be asymptomatic or present with:<ref name="pmid220851203">{{cite journal| author=Clouston D, Hall A, Lawrentschuk N| title=Penile lichen sclerosus (balanitis xerotica obliterans). | journal=BJU Int | year= 2011 | volume= 108 Suppl 2 | issue= | pages= 14-9 | pmid=22085120 | doi=10.1111/j.1464-410X.2011.10699.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22085120 }}</ref>
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| Whitening or reddening of the penile region
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| * Difficulty in retracting the foreskin
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| * Painful erection
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| * Reduced urinary flow
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| * Urinary retention
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| * Buring sensation ( paraesthesia)(rare)
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| * purple rash in gential region( purpura)(rare)
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| * Small red or purple clusters, often spidery in appearance, on penis(telangiectases)(rare)
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|
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| *Itching (pruritus) of the genitalia.rare
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| *Discomfort in urination(dysuria)rare
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| ===Physical examination===
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| Physical examination findings include:<ref name="pmid220851204">{{cite journal| author=Clouston D, Hall A, Lawrentschuk N| title=Penile lichen sclerosus (balanitis xerotica obliterans). | journal=BJU Int | year= 2011 | volume= 108 Suppl 2 | issue= | pages= 14-9 | pmid=22085120 | doi=10.1111/j.1464-410X.2011.10699.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22085120 }}</ref>
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| * Whitening or reddening of the glans penis, foreskin (prepuce) and coronal sulcus
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| * Induration of the glans and foreskin
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| * Phimosis(rare)
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| * Purpura(rare)
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| * Telangiectases(rare)
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|
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| ===Laboratory findings===
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|
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| [[Tzanck smear]] and [[Skin|cutaneous]] [[biopsy]], along with a rapid protein reagin test, will provide a definitive diagnosis."
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| {| class="wikitable"
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| !
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| !
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| !
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| !
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| |Tzanck smear
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| |Cutaneous biopsy
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| |}
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|
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| ==Treatment==
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|
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| Medical therapy for BXO include:<ref name="pmid220851202">{{cite journal| author=Clouston D, Hall A, Lawrentschuk N| title=Penile lichen sclerosus (balanitis xerotica obliterans). | journal=BJU Int | year= 2011 | volume= 108 Suppl 2 | issue= | pages= 14-9 | pmid=22085120 | doi=10.1111/j.1464-410X.2011.10699.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22085120 }}</ref><ref name="pmid21396563">{{cite journal| author=Sagi L, Trau H| title=The Koebner phenomenon. | journal=Clin Dermatol | year= 2011 | volume= 29 | issue= 2 | pages= 231-6 | pmid=21396563 | doi=10.1016/j.clindermatol.2010.09.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21396563 }}</ref><ref name="pmid11204255">{{cite journal| author=Das S, Tunuguntla HS| title=Balanitis xerotica obliterans--a review. | journal=World J Urol | year= 2000 | volume= 18 | issue= 6 | pages= 382-7 | pmid=11204255 | doi=10.1007/PL00007083 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11204255 }} </ref><ref name="pmid8863582">{{cite journal| author=Hrebinko RL| title=Circumferential laser vaporization for severe meatal stenosis secondary to balanitis xerotica obliterans. | journal=J Urol | year= 1996 | volume= 156 | issue= 5 | pages= 1735-6 | pmid=8863582 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863582 }} </ref><ref name="pmid9043588">{{cite journal| author=Rudolph R, Walther P| title=Full-thickness skin grafts from eyelids to penis, plus split-thickness grafts in chronic balanitis xerotica obliterans. | journal=Ann Plast Surg | year= 1997 | volume= 38 | issue= 2 | pages= 173-6 | pmid=9043588 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9043588 }} </ref><ref name="pmid8863582">{{cite journal| author=Hrebinko RL| title=Circumferential laser vaporization for severe meatal stenosis secondary to balanitis xerotica obliterans. | journal=J Urol | year= 1996 | volume= 156 | issue= 5 | pages= 1735-6 | pmid=8863582 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863582 }} </ref><ref name="pmid17180441">{{cite journal| author=Singh I, Ansari MS| title=Extensive balanitis xerotica obliterans (BXO) involving the anterior urethra and scrotum. | journal=Int Urol Nephrol | year= 2006 | volume= 38 | issue= 3-4 | pages= 505-6 | pmid=17180441 | doi=10.1007/s11255-006-0100-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17180441 }} </ref><ref name="pmid21210959">{{cite journal| author=Garaffa G, Shabbir M, Christopher N, Minhas S, Ralph DJ| title=The surgical management of lichen sclerosus of the glans penis: our experience and review of the literature. | journal=J Sex Med | year= 2011 | volume= 8 | issue= 4 | pages= 1246-53 | pmid=21210959 | doi=10.1111/j.1743-6109.2010.02165.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21210959 }} </ref>
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| {| class="wikitable"
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| ! colspan="3" |Various medical managements for BXO
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| !
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| !Drug dosage
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| !Effectiveness
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| |Topical steroids
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| |Betamethasone diproprionate 0.05% or or clobetasol proprionate 0.05% cream or ointment once or twice daily
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| After 6–8 weeks, reduce the application of the topical steroid to every second day
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|
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| After 12–16 weeks to assess response to treatment(mometasone aceponate 0.1% cream can be substituted if there is a good response)
| |
|
| |
| No improvement by 6 months, then use of the potent topical steroid should be abandoned.
| |
|
| |
| |3 out of 6 patients responded
| |
| |-
| |
| | rowspan="2" |Topical calineurin inhibitors
| |
| |Tacrolimus ointment 0.1% twice daily
| |
| | rowspan="2" |Shouldn't be used as first-line therapy
| |
| |-
| |
| |Pimecrolimus cream 1% twice daily
| |
| |-
| |
| | rowspan="2" |Tricyclic antidepressant or gabapentin.
| |
| | colspan="2" rowspan="2" |Can be used in cases when BOX is associated with penile dysaesthesia.
| |
| |-
| |
| |-
| |
| | colspan="3" |
| |
| === Surgery ===
| |
| |-
| |
| | colspan="3" |
| |
| * Surgical treatment often involves circumcision. Trial of steroids is usually prescribed before subjecting patients for surgery. Phimosis is an indication for surgery. In patients with severe BXO may require an extensive surgery with disease control, function and cosmesis in carefully balanced.
| |
| * Some cases may require meatoplasty, extensive urethroplasty and reconstructions.
| |
| * Patients who undergo surgery should be follow up as the disease as tendency to recur.(BOX as high tendency to recur due to koebner phenomenon)
| |
| * Patients should be advice for regular testicular self-examination and should be advice to return if the lesion revur.
| |
| |-
| |
| | colspan="3" |
| |
| === Prospective therapies ===
| |
| |-
| |
| | colspan="3" |Intralesional corticosteroids, topical and intramuscular testosterone, intravenous procaine, topical oestrogen and retinoid creams, oral vitamin E, radiation therapy and CO2 laser are currently been studies for there role in treating BOX
| |
| |}
| |
|
| |
| === <section></section>Prevention ===
| |
| There is no known means of preventing BXO. However, one study reports that the data "suggest that circumcision prevents or protects against common infective penile dermatoses."<ref name="mallon20002" />
| |
| ===Primary Prevention===
| |
| Circumcision in males can help in reducing risk of having BXO.<ref name="pmid2789094532">{{cite journal| author=Dayal S, Sahu P| title=Zoon balanitis: A comprehensive review. | journal=Indian J Sex Transm Dis | year= 2016 | volume= 37 | issue= 2 | pages= 129-138 | pmid=27890945 | doi=10.4103/0253-7184.192128 | pmc=5111296 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27890945 }}</ref>
| |
| ===Secondary prevention===
| |
| There is no secondary prevention measures.
| |
| ==References==
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| {{Reflist|2}}{{Lipopedia}}{{WikiDoc Help Menu}} {{WikiDoc Sources}}<section></section><section><section></section><section></section></section>
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| [[Category:Balanitis]]
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| [[Category:Infectious diseases]]
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