Dermatologist Should Be Consulted

From a dermatologist’s perspective—as the doctor who usually undertakes the diagnosis and therapy of lichen sclerosus (LS)—I wish to point out that genital LS occurs in adults more often than in children, and the even rarer extragenital LS affects primarily older women.

In case of not-retractable phimosis, it is too late for conservative treatment, but in the remaining cases this is still promising. If highly potent steroids are used at all they should be applied for a maximum of one week only because of atrophy and increased resorption in the genital region. After a week, patients should be switched to treatment with methylprednisolone aceponate, mometasone, hydrocortisone, or topical calcineurin inhibitors instead. In hypertrophic forms of LS, tretinoin-containing external medications and imiquimod have their uses. In sclerotic hardening with possible functional impairment of the prepuce, frenulum, glans, and perimeatal area, the situation can be rapidly improved by means of cryotherapy, best administered in spray form; surgical treatment can thus mostly be avoided.

In the conclusions section, the author recommended presenting suspect skin changes to a pediatric surgeon or urologist, but he forgot to mention the dermatologist, who is used to treating LS and is often able to prevent surgical treatment by administering appropriate topical treatment. In LS, complete circumcision is not always the treatment of choice because later, or even simultaneously, glans, meatus, and frenulum may be affected, and this cannot be eliminated by means of circumcision nor can it be prevented for the future.

DOI: 10.3238/arztebl.2011.0694b

Nicole Kemmler

Dermatologische Abteilung des Landeskrankenhauses

Feldkirch, Österreich; nicole.kemmler@lkbf.at

Conflict of interest statement
The author declares that no conflict of interest exists.