Management of topical steroid therapy in male patients with lichen sclerosus after circumcision

TL;DR

This study compares the effectiveness of circumcision versus topical steroids in managing lichen sclerosus in men, finding that circumcision improves quality of life but relapses are common.

Contribution

The study provides new insights into personalized treatment strategies for lichen sclerosus by comparing surgical and topical therapies.

Findings

Circumcision significantly improves quality of life in men with lichen sclerosus.

Resumption of topical steroids after surgery correlates with prior treatment use.

Topical therapies alone do not significantly impact quality of life.

Abstract

Lichen Sclerosus et Atrophicus (LSA) is a chronic inflammatory dermatosis of multifactorial aetiology, mainly affecting the genital area in both sexes and at any age. First-line therapy involves topical corticosteroids, whilst surgery, particularly circumcision in males, is reserved for non-responders or phimosis cases. Some patients show persistent disease post-surgery. The study aims to compare the effectiveness of circumcision versus topical corticosteroids in improving QoL in men with LSA, assess postoperative recurrence risk.

A retrospective study of consecutive male patients with histological or clinical genital LSA were undergone. We collected clinical, anamnestic, and therapeutic data, including pre- and post-circumcision topical treatments. The DLQI questionnaire assessed quality of life according to treatment type.

Fifty-five males were analysed; 40% underwent circumcision. Of these, 83% used topical steroids before surgery and 68% resumed afterward (Steroid-Free Survival: 19 months). Resumption correlated with prior treatment (p = 0.043). QoL improved after circumcision and worsened with active therapy or phimosis (p = 0.002; p = 0.006).

Circumcision improves QoL, especially in phimosis, though relapses are frequent. Topical therapies are commonly employed but do not appear to significantly impact QoL. The results underline that LSA management should be personalised, combining medical and surgical approaches based on severity and patient response.