TIGHT FORESKIN DUE TO LICHEN SCLEROSIS
WHAT IS BALANITIS XEROTICA OBLITERANS (BXO) FORESKIN?
BXO is a thin white crinkly patch that appears on the foreskin. It can be troublesome if this is not treated. This causes tight foreskin in children and adults. This is also known as lichen sclerosis atrophicus or Csillag’s disease or white spot disease.
WHO GETS THE BXO?
BXO is a disease affecting uncircumcised males ranging from young boys to adolescents and adults. This is the commonest cause of tightening of the foreskin (BXO phimosis)
WHAT CAUSES THE BXO?
The exact cause of BXO is not known. Sometimes it is associated with diseases in which the body’s immune system attacks normal tissues. Despite the tendency to affect the genital skin, BXO is not an infection – the disease is not contagious, so sexual partners cannot pick it up. Rarely, BXO can occur in relatives.
WHAT ARE THE SYMPTOMS OF BXO?
Many patients have none, but the most common symptom of BXO is itching. As a rule, the patches on the foreskin itch and can also hurt if the skin breaks down or cracks. In the genital area, the scar-like process can tighten the skin, and this can interfere with sexual intercourse in affected men. BXO can make the foreskin tight and difficult to retract, and can even partly block the flow of urine.
WHAT DOES BXO LOOK LIKE?
On the main areas of the foreskin, the spots of BXO look like small ivory-coloured slightly raised areas, which can join up to form white patches. Some have tiny yellowish horny plugs within the pale areas. After a while, the surface of the spots can look like wrinkled tissue paper. The most common sites are the bends of the wrists, the upper trunk, around the breasts, the neck and armpits. Sometimes this causes no symptoms and they may not even know it is there.
The white thin, fragile areas, sometimes surrounding the foreskin in a figure of eight patterns, have a crinkly surface; their fragility may lead to easy bruising and erosions. Later on, the foreskin opening can shrink, leading to pain with intercourse. Less often BXO can develop in children. It can make a retraction of the foreskin difficult and interfere with passing water and sexual activities. BXO can be confused with thrush infection.
HOW WILL BXO BE DIAGNOSED?
The diagnosis of BXO can usually be made from the typical appearance of the condition. This will be confirmed after the examination of the foreskin skin (a biopsy) under the microscope.
CAN THE BXO BE CURED?
No treatment is likely to reverse the changes of BXO completely, but the symptoms and signs of the disease can usually be well controlled with a steroid application.
HOW CAN BXO BE TREATED?
A variety of treatments are available for BXO. Your symptoms can be relieved by the use of steroid creams or ointments. Bland moisturisers help to soften and protect the skin. In adults, tightening of the foreskin will often respond to steroid ointments; if not, a circumcision may be worth considering. In children, circumcision is usually required.
The fragile skin of BXO may be more susceptible than normal skin to infection with Candida yeasts (thrush) or bacteria and may split or even bleed. We will treat these problems if they arise.
WHAT CAN YOU DO?
Cancer of the penis maybe a little more likely to occur in BXO that has been present for many years than in normal skin. If you have any lumps or non-healing sores in that area you should ask your doctor to look at them.
It is very important to follow with your GP or Urologist if BXO persist even after circumcision and treatment
SELF CARE (What can you do?)
- Avoid washing with soap and instead use an emollient soap substitute/ cream to wash. Many different non-perfumed creams can be used, however, the aqueous cream can lead to irritation in some men and should be avoided.
- Carefully dry yourself after passing urine, thus reducing the contact of urine with your skin.
- Using a moisturiser or yellow soft paraffin (such as Vaseline) as a barrier cream can protect your skin from exposure to urine.
- Keep pubic hairs trimmed so they do not get trapped between the foreskin and the penis.
- A lubricant for sex will reduce excessive friction.
- If you are a smoker, stop smoking to reduce the risk of penis cancer.
- Lifelong regular self-examination is very important for all men who have or have had genital lichen sclerosus. If any skin changes develop which do not respond to steroid creams, in particular any persistent skin thickening or soreness, it is important to tell the doctor without delay. A skin biopsy may be necessary to test for skin cancer. (Ref: British Association of Dermatologists Feb 2017)
Price for adult circumcision with frenuloplasty £625 with Glue and biopsy £130 in case of BXO
Adult circumcision in London is the best circumcision clinic for the management of tight foreskin with penile BXO.
PATHWAY FOR PATIENTS WITH PHIMOSIS DUE TO BXO IN OUR CLINIC
- Assessment and advice for the option of treatment like steroid cream, preputioplasty, circumcision or further operations
- Consultation before the circumcision
- Circumcision with glue because glue circumcision is better than stitches
- Aftercare advice following the circumcision
- To send the biopsy to confirm the diagnosis and exclude any malignancy
- Further treatment after 6 weeks of circumcision
- Advice to follow up to your GP or at our clinic with Dr Khan
- Long term follow up required if biopsy-proven BXO is found after the circumcision
Please contact us for specialist and professional opinion.
PS: This information is only for guidance. This is not a replacement for professional medical advice. Please Dr Khan for free telephone advice +447527314081 without any obligation