Abstract
Lichen sclerosus et atrophicus is a chronic inflammatory sclerotic and atrophic disease of unknown cause that predominantly affects male and female genital skin. This study was designed to evaluate histological characteristics of congenital and acquired phimoses among pediatric (n=60) and adult (n=60) male patients who were admitted for circumcision to the Clinics of Urology and Pediatric Surgery of Kaunas University of Medicine Hospital between 2000 and 2003 and to determine the rate of lichen sclerosus et atrophicus and other histological diagnoses among them. This study demonstrates that 45.1% of congenital and 62.3% of acquired phimoses show histological signs of lichen sclerosus et atrophicus. The rate of lichen sclerosus et atrophicus was statistically significantly higher among patients with acquired than congenital phimosis. Boys with acquired narrowing of prepuce were statistically significantly 3.9 times more likely to develop lichen sclerosus et atrophicus than those with congenital phimosis. There were no statistically significant differences between rates of lichen sclerosus et atrophicus and other dermatological diagnoses among pediatric and adult male patients if the type of phimosis (acquired or congenital) was considered. Histological features of lichen sclerosus et atrophicus and other histological diagnoses in boys and men with phimosis were detected with equal frequency irrespective the age of the subjects. The rate of lichen sclerosus et atrophicus was similar among all boys (56.7%) and men (53.3%) treated for phimosis. Only the type of phimosis had a statistically significant influence on the rate of lichen sclerosus et atrophicus and other histological diagnoses.
Highlights
Phimosis is a clinical condition when the foreskin cannot be drawn back to uncover the glans penis
Among pediatric and adult male patients studied, congenital phimosis was diagnosed in 70% (n=42) and 15% (n=9), and acquired – in 30% (n=18) and 85% (n=51) of patients, respectively
A logistic regression analysis indicated that boys with acquired phimosis were 3.9 times more likely to develop Lichen sclerosus et atrophicus (LSA) compared to boys with congenital phimosis
Summary
Phimosis is a clinical condition when the foreskin cannot be drawn back to uncover the glans penis. This condition may be either congenital (continues from birth) or acquired (previously being retractable foreskin contracts). This is a relatively rare inflammatory disease of skin and mucosa that is characterized by a chronic course, unknown etiology, and insufficiently clear pathogenesis. The disease may start at any site of the body in subjects of any age and sex. It mostly targets the site of external genitals in men as well as in women. Typical cases of LSA show discrete lichenoid dermatitis with vacuolization of the basal layer of the epidermis and homogenization and sclerosis of the superficial dermis
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