Prevalence and sequelae of penile lichen sclerosus in males presenting for circumcision in regional Australia: a multicentre retrospective cohort study

Kwok, Michael; Shugg, Nathan; Siriwardana, Amila; Calopedos, Ross; Richards, Katherine M.; Bandi, Sanjeev; Hempenstall, John; Rashid, Prem; Desai, Devang

doi:10.21037/tau-22-29

Cited by 6 publications

(13 citation statements)

References 24 publications

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“…In contrast to these findings, according to a study conducted among 313 patients who went through circumcision and their specimens sent for histopathological examination, a recurrence of lichen sclerosis was found in 199 (63.6%) cases [ 123 ]. According to another study, the curative rate of circumcision was 76%, but 24% of cases required ongoing medical therapy as well, regardless of circumcision [ 8 ].…”

Section: Reviewmentioning

confidence: 99%

Penile Lichen Sclerosis: A Surgical Perspective of its Aetiology and Treatment

Bhambhani¹,

Bhambhani²,

Pandya³

2022

Cureus

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Penile lichen sclerosis is a longstanding inflammatory disease of the skin with a controversial aetiology. Penile lichen sclerosis (PLS) is a growing, inflammatory dermatitis of the anogenital region, which involves the meatus, prepuce, penile shaft, and glans penis. Although the accurate aetiology of PLS is contentious, multiple factors including genetics, autoimmunity, infections of human papillomavirus, hepatitis C, Epstein-Barr virus, risk factors (hormonal and trauma), etc., can be considered to be a part of the etiopathogenesis of PLS. The initial clinical presentations of penile lichen sclerosis are white plaques, atrophied skin, erythema, erosions, and sclerosis in the anogenital region. When the disease advances, the following can occur, including meatal constraints, telangiectasia, petechiae, soreness, papular lesions, tightness of the foreskin, difficulties in passing urine, itching, tenderness on erections, pain, cracking, bleeding, redness, rashes, tightness at frenulum, and dysuria. This disease has a dangerous course of action and if untreated it may be linked with severe urologic and sexual morbidities. PLS is usually treated with medical and surgical interventions like topical or intralesional steroids and circumcision. The role of circumcision is very critical in the course of action and prognosis of PLS, and its treatment is dependent on the stage of the disease. This review brings up the knowledge regarding epidemiology, etiopathology, clinical presentation, and management of PLS with an emphasis on the role of circumcision.

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Section: Reviewmentioning

confidence: 99%

Penile Lichen Sclerosis: A Surgical Perspective of its Aetiology and Treatment

Bhambhani¹,

Bhambhani²,

Pandya³

2022

Cureus

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“…8,10 There is a potential for malignancy, with vulvar squamous cell carcinoma developing in females 11 and penile squamous cell carcinoma in males. 9 A skin biopsy may be necessary in cases of uncertainty regarding LS or suspicion of malignancy. 1,8,12,13 Multiple factors are considered to play a role in the development of genital LS; however, the exact etiology remains unknown.…”

Section: Introductionmentioning

confidence: 99%

The impact of genital lichen sclerosus in men and women on quality of life: a prospective cohort study

Jerkovic Gulin,

Liljeberg,

Seifert

2024

International Journal of Women’s Dermatology

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Background: Genital lichen sclerosus (LS) is a chronic inflammatory skin disorder that affects both sexes of all ages. The clinical characteristics include erosions, redness, and white plaques with atrophic skin, with symptoms such as pruritus, pain, dysuria, and dyspareunia. Objective: This prospective cohort study aimed to assess quality of life (QoL) in men and women with genital LS, both before and after treatment, using the Dermatology Quality of Life Index (DLQI) questionnaire. Methods: Patients diagnosed with genital LS were enrolled continuously in the study and were asked to complete the DLQI questionnaire before treatment and again after individualized treatment 12 weeks apart. Results: This study included 136 patients (48 females and 88 males) diagnosed with genital LS, with a median age of 62 years (range 18–86). The results showed a statistically significant decrease (P < .001) in DLQI score before treatment (median 6.0 [interquartile range (IQR), 1.0–11.0]) compared to after treatment (median 2.0 [IQR, 0.0–4.0)]. In males and females, the median DLQI scores before treatment were 3.0 (IQR, 0.0–10.0) and 8.0 (IQR, 4.5–11.5), respectively, and after treatment were 1.0 (IQR, 0.0–3.0) and 4.0 (IQR, 0.0–9.0), respectively. Females scored significantly higher (P < .001) than males. Limitations: The study’s limited generalizability stems from a small sample size of 136 patients, potentially restricting the application of findings to a broader population with genital lichen sclerosus. Additionally, the 12-week follow-up period may not adequately capture the long-term effects of interventions on quality of life. Reliance on self-reported data through the DLQI questionnaire introduces the possibility of bias, as participants may not accurately represent their symptoms and quality of life. The absence of a control group hinders the ability to attribute observed changes solely to the treatment, and the lack of detail on specific interventions makes it challenging to assess the effectiveness of individualized treatment approaches. The wide age range among participants (18–86 years) introduces potential confounding variables, as different age groups may respond differently to treatment. Conclusion: The study findings confirmed that individuals with genital LS experience a small decline in QoL, as observed in both males and females. This study also highlights that effective management of genital LS can significantly improve QoL in both sexes.

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“…Should we care if the questions posed above and by Kwok et al ( 21 ) are answered? The basic tenant of medicine of non-maleficence, primum non nocere , may be kept in mind.…”

mentioning

confidence: 99%

“…The article in the current issue of Translational Andrology and Urology , by authors Kwok et al ( 21 ) from Australia, on a multi-centered retrospective study presents interesting population data regarding the histology of circumcision specimens and the sequelae to circumcision. Though their study does not give a definitive answer to the questions at hand, their research adds substantial data to information regarding prevalence of LS in males with phimosis.…”

mentioning

confidence: 99%