Adjuvant Topical Treatment With Inflammation: Suppressing Medications Should Be Given

The comprehensive article “Lichen sclerosus in boys” contributes to raising awareness for lichen sclerosus (LS) and to ensuring that it is appropriately rated in terms of its importance even in children. The author retrospectively reports of his enormous patient cohort; however, a 4-month follow-up period is under no circumstances enough to capture possible complications. Furthermore, the key messages suggest that LS can be cured by complete circumcision. Prospective data disproved this statement as early as in 1994, since one third of the glandular lichenoid lesions that were observed in 70% of cases persisted after 5 years without aftercare (1).

In our pediatric urology patient collective we found in 45% of circumcised LS patients after they had healed that the glans and/or meatus were affected (2). The British Association of Dermatologists additionally deems adjuvant topical treatment with anti-inflammatory topical ointment after a histologically confirmed diagnosis of LS (3). Postoperative complications that are to be expected—in the present article these mainly included meatus stenosis in 10.7% and renewed phimosis in spite of circumcision in 50%—justify adjuvant and therapeutic application of anti-inflammatory topical substances, such as cortisone or tacrolimus, even in children because otherwise these small patients would have to endure repeated surgery under general anesthesia. We published our prospective data on adjuvant treatment with a topical tacrolimus ointment for a follow-up period of >1 year (2) and, even after a long-term follow-up of a median 2.8 years have not had to undertake a single secondary procedure in such topically treated LS.

In conclusion it does need to be pointed out that unfortunately the “buried penis”—with or without histologically confirmed LS—should never be treated by simple circumcision because this does not do justice to the complexity of the case in any way.

DOI: 10.3238/arztebl.2011.0694c

PD Dr. med. Anne-Karoline Ebert

Klinik für Kinderurologie in Kooperation mit dem Lehrstuhl für Urologie
der Universität Regensburg in der Klinik St. Hedwig, Regensburg

anne-karoline.ebert@barmherzige-regensburg.de

Conflict of interest statement

The author declares that no conflict of interest exists.