Lichen sclerosus of men genitalia is usually called balanitis xerotica obliterans (BXO). This is progressive scarring with inflammatory disease of the head of the penis (also called glans penis) and foreskin. It may cause tight foreskin (called phimosis).  BXO has a significant abnormality which sometimes associated with urinary obstruction and sexual dysfunction. Medical treatment with steroids may require in early BXO.  Circumcision is indicated in the case of the tight foreskin (phimosis) due to BXO or foreskin trapped beyond the head of the penis during sexual activity (paraphimosis).

The following pathway should be adopted in the management of lichens sclerosis (BXO) phimosis

• Assessment and advice will require for the different option of treatments of BXO by our specialist Urologist 

• Consultation is important before the circumcision and other surgical procedures to know about the management. 

• Circumcision, biopsy and urethroplasty are surgical options.

• Follow up advice following the circumcision is an important part of the long-term advice. 

• Good practice to send a foreskin biopsy to confirm the diagnosis and exclude any skin cancer 

• Further steroid treatment may require treating the remaining BXO over the head of the penis after 4-6 weeks of circumcision

• Long term follow-up is required if biopsy proven BXO found after the circumcision   

Disclaimer: This information is not the replacement of medical professional advice. Please contact us for professional consultation.

Reference: Kwok R, Shah TT, Minhas S. Recent advances in understanding and managing Lichen Sclerosus. F1000Research. 2020;9.