Comparison of lichen sclerosus in boys and girls: A systematic literature review of epidemiology, symptoms, genetic background, risk factors, treatment, and prognosis

Abstract

Lichen sclerosus (LS), first described by Breisky (1885) and Hallopeau (1887), is a chronic inflammatory skin disease which predominantly affects the anogenital region. 1,2 LS is relatively common in postmenopausal women, with an estimated prevalence between 1:1000 and 1:60. 3,4 In men, LS seems less common 5 ; the reported ratio between men and women varies from 1:10 to 1:6. 6,7 The disease is well-documented in adults; less is known regarding LS in children. In addition, many publications address LS in either boys or girls, but not both. Therefore, we aim to assess the literature on LS in both boys and girls. LS has been known by various synonyms such as white spot disease, kraurosis vulvae, lichen sclerosus et atrophicus vulvae or, in men, balanitis xerotica obliterans (BXO). For consistency, in this review, we uniformly use the term lichen sclerosus.

Post‐operative steroids in boys with histologically proven balanitis xerotica obliterans reduce the need for subsequent meatal dilatation

“…The steroids used in the department are hydrocortisone 1%, betamethasone 0.5% and triamcinolone. All were shown in previous studies to have comparable results with BXO 5,14,15 …”

“…All were shown in previous studies to have comparable results with BXO. 5,14,15 In the first follow-up, patients with symptomatic meatal senosis (pin hole meatus, straining, enuresis or frequency more than 8 micturations/day) are offered a second surgery. 16 This is in the form of meatoplasty + dilatation according to the intra-operative findings.…”

“…[2][3][4] Atopy and obesity are proposed risk factors. 5 Circumcision is regarded as the treatment of choice and is considered curative. 6 More recently, the use of topical steroids as primary therapy has been advocated.…”

“…2 Even in patients undergoing circumcision, the rate of meatal stenosis necessitating a subsequent meatal procedure range between 7% and 20%. 3,5 There is evidence available suggesting that post-operative topical steroids can reduce the need for further meatal procedures; however, steroids tend to be prescribed only when the patient is observed to have an abnormal meatus at circumcision, leading to selection bias. 2 The management of BXO, in our department, is primary circumcision.…”

“…It is a chronic inflammatory process, which affects the prepuce but can also extend onto the glans and external urethral meatus leading to meatal stenosis 2–4 . Atopy and obesity are proposed risk factors 5 …”