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Skin Care and Diseases

Balanits Xerotica Obliterans?

10/13/2005

Question:

I am 30 years old. Two months ago I developed a rash on my penis that a dermatologist diagnosed as a yeast infection -- the symptoms were redness where the frenulum attached to the glans and around the urethra. There were small, circular lesions on the top of the glans and on the phimotic band. I applied Econazole and Desonide that the dermatologist prescribed. The condition did not improve and, in fact, I developed severe phimosis. Fearful that I was soon not going to be able to urinate, I went to the ER. They prescribed an antibiotic (augmentin) and diflucan -- within 5 days, the swelling had subsided to the point that I could retract my foreskin all the way. The yeast infection seemed to be gone. Now, the area near the frenulum continues to be slightly red, but it is not painful or inflamed. There are straight line and wavy fissures on the phimotic band, which is only slightly tight. I honestely can`t tell whether the fissures are lesions or scars -- they do not hurt. What really concerns me is what I think is a new symptom. The distal part of my glans (where the redness used to be) is slick and gray-white. In fact, the grayness runs around the entire base of the glans. It is not at all painful, but it looks odd. Could this be BXO? How can I treat it? Will it become painful or interfere with my sex life/urination at some point?

Answer:

It is a bit unusual to have balanitis xerotica obliterans (lichen sclerosis et atrophicus) on the male genitalia in younger age groups.  It is of course seen even in teenage and younger years, and is seen in both sexes.  Treatment in the last few years has been rather focused on high potency class I or class II steroid ointments to the precise area of involvement.  Instead of producing atrophy and thinning there has been restoration of near normal appearance and function.  As you have noted you do have breaking of the mucus membrane and that is typical of balanitis xerotica obliterans.  Over a period of many decades, if untreated, significant atrophy of the glans and the urethra meatus may occur. 

I would suggest that with proper treatment and monitoring you can minimize the long-term effects of the disease and hopefully avoid the hemorrhage and discomfort that can occur in far advanced disease. 

Many in the urologic community perform circumcisions in patients with the problem, only to have increasing erosion of the glans.  If you are already circumcised, I think I would not worry about that issue.  I would urge you to seek out the care of a board certified dermatologist to help you with the selection of a topical medication and with long-term monitoring.

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Response by:

Charles L Heaton, MD
Professor
College of Medicine
University of Cincinnati