Male genital lichen sclerosus (MGLSc) is a chronic inflammatory skin disease responsible for male sexual dyspareunia and urological morbidity. An afeared complication is squamous cell carcinoma (SCC) of the penis. The precise etiopathogenesis of MGLSc remains controversial although genetic, autoimmune and infective (such as human papillomavirus (HPV) hepatitis C (HCV), Epstein-Barr virus (EBV) and Borrelia) factors have been implicated: Consideration of all the evidence suggests that chronic exposure of susceptible epithelium to urinary occlusion by the foreskin seems the most likely pathomechanism. The mainstay of treatment is topical ultrapotent corticosteroid therapy. Surgery is indicated for cases unresponsive to topical corticosteroid therapy, phimosis, meatal stenosis, urethral stricture, carcinoma in situ (CIS) and squamous cell carcinoma.

Introduction Male genital lichen sclerosus (MGLSc) is an acquired, chronic, inflammatory skin disease that is associ-

Contact dermatitis accounts for 70-90% of all occupational skin diseases. 1 It is an inflammatory skin condition induced by exposure to an external irritant or allergen (table 1⇓). A prevalence of 8.2% was seen in a recent cross sectional study of 12 377 subjects across five European countries, in which a randomly selected group of 3119 patients were patch tested. 2 The condition can have a detrimental impact on personal and social relationships, quality of life, and even threaten employment. [3][4][5] What are the different types of contact dermatitis?Irritant contact dermatitis is a non-immunologic response that occurs as a consequence of direct damage to the skin, by chemicals or physical agents, faster than the skin is able to repair itself. 6 7 Approximately 80% of cases of contact dermatitis are irritant contact dermatitis. 8 Common irritants include soaps, detergents, water, solvents, cutting oils, and food ingredients. 8 The hands, particularly finger web spaces (fig 1⇓), and the face are commonly affected. 6 Allergic contact dermatitis comprises 20% of cases of contact dermatitis. It is a type IV delayed hypersensitivity reaction to an external allergen, which occurs only in an individual who has previously been sensitised. 6 Re-exposure to the allergen results in circulating memory T cells homing in to the skin and eliciting an immunologic reaction that causes skin inflammation, typically within 48 hours. [9][10][11][12][13] For personal use only: See rights and reprints

Male genital lichen sclerosus (MGLSc) is responsible for male dyspareunia, urological morbidity and squamous carcinoma of the penis. The aetiology is essentially unknown but an autoimmune mechanism is most favoured. The first author of this paper (CBB) has argued that chronic, occluded, exposure of susceptible epithelium to urine is perniciously central to the pathogenesis (1-3). MGLSc never occurs in men who were circumcised at birth; it is associated with trauma, instrumentation, genital jewelry (piercing), and gross anatomical abnormalities (e.g. fi-ank hypospadias); it recurs in grafts, and it rarely causes perianal disease: in striking contrast with women, the male perineum is rarely chronically exposed to urinary irritation (3). Sub-preputial wetness has been associated with foreskin length and balanitis (4, 5), however GLSc has not been linked to napkin or diaper dermatitis in children although there has been a report associating it with incontinence in the elderly (6).Symptomatology associated with the leaking or dribbling of small amotmts of urine (micro-incontinence) in men may not be readily volunteered or elicited. However, it has become apparent to CBB over many years of interviewing men with GLSc that such symptomatology is frequently present. METHODSTo attempt to quantify the presence of this symptomatology in MGLSc 3 approaches to the clinical records of cases were employed.Firstly, we scrutinised the Male Genital Dermatoses Clinic (MGDC) at one of our institutions. The work load of this clinic has been described (7) as has the spécifie experience of MGLSc (3). For the last four years, each new case presenting to the weekly MGDC has been assessed by the attending physician using a routine, standard, structured form to record symptoms and signs. The patient is asked specifically about his urinary voiding patterns and habits; explicit questions are asked about post-mieturition micro-incontinence (i.e. leaking or dribbling of small quantities of urine from the urinary meatus). Over a 12 month period, all those patients, uncircumeised at presentation, diagnosed with imequivocal MGLSc (diagnosed either by punch biopsy or post-circumcision preputial specimen histologieal analysis) were identified at follow-up. A similar number of patients with an unequivocal alternative diagnosis was identified. The initial clerking forms of these MGLSc and non-MGLSc cases were then inspected to determine their presenting symptomatology.The second approach was to review the initial clerking forms of all new cases of male genital skin disease seen in 4 consecutive MGDCs and correlate the responses to the questions about voiding with the working clinical diagnosis in each case.Finally, we retrospectively reviewed the records and/or clinic letters of all the patients diagnosed clinically with MGLSc in the general dermatology clinics done by one of us in another institution over a one-year period. RESULTSIn the first study (from Spring 2010 to Spring 2011) 17 patients (mean age±SD 45.9 ±14.4 years) were identified with hist...

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We are also grateful to our colleagues at various health care centers for bringing these patients to our attention and providing knowledge and expertise in the individual cases. These persons were not compensated for their contributions.

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