Lichen sclerosus in paediatric patients with phimosis undergoing circumcision

TL;DR

This study finds that lichen sclerosus is a common but underdiagnosed cause of phimosis in boys, with many cases misclassified as normal phimosis.

Contribution

The study reveals a significant discrepancy between clinical and histological diagnoses of lichen sclerosus in pediatric phimosis cases.

Findings

71% of pediatric phimosis cases showed histological evidence of lichen sclerosus.

70% of cases clinically labeled as physiological phimosis were found to have lichen sclerosus.

Clinical and histological diagnoses showed only slight agreement (Kappa value of 0.027).

Abstract

Male genital lichen sclerosus is a relatively uncommon but increasingly recognized cause of phimosis in paediatric patients.

To investigate the presence of male genital lichen sclerosus (MGLS) in paediatric patients presenting with phimosis and to evaluate the diagnostic accuracy of clinical assessment compared with histopathological findings.

We conducted a single-centre, retrospective study of 48 paediatric circumcisions performed for phimosis over an 18-month period. Clinical diagnoses of phimosis were categorized as physiological or pathological and compared with postoperative histopathological findings. To quantify diagnostic reliability, percentage agreement and Cohen’s kappa coefficient were used.

MGLS was confirmed histologically in 71% of patients, with the highest proportion occurring in boys aged 9–11 years. Among those clinically diagnosed with physiological phimosis, 70% showed histological evidence of MGLS, of whom 48% exhibited extensive disease. The overall concordance between clinical and histological diagnoses was 43.75%, with a Kappa value of 0.027, indicating only slight agreement.

Currently, clinical assessments seem to underestimate the proportion of cases with MGLS, especially among younger boys. Enhancing awareness and recognition of this condition is essential to facilitate accurate and timely diagnosis, and to guide appropriate interventions, thereby preventing disease progression and reducing associated morbidity.

Male genital lichen sclerosus (MGLSc) is a chronic dermatosis and a key factor in paediatric pathological phimosis, yet its presence is often underestimated. In this study, 71% of cases of paediatric circumcision for phimosis showed histological evidence of MGLSc. Alarmingly, 70% of cases clinically diagnosed as physiological phimosis were confirmed as MGLSc, revealing significant discrepancies between clinical and histological diagnosis that warrant a reevaluation of clinical approaches to this condition. These findings emphasize the need for heightened awareness of the presence of this condition to facilitate timely diagnosis and mitigate disease progression.

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