Balanitis Xerotica Obliterans

Balanitis xerotica obliterans (BXO) — lichen sclerosus of the penis. May be caused by chronic intermittent damage from urine occluded under the foreskin. Carries a 5% lifetime risk of SCC. More common in uncircumcised men.

Examination

A well-defined, white, finely wrinkled plaque that is firm and scarred. The urethra may narrow, causing a thin, crooked stream; phimosis may develop. Sexual dysfunction can follow, from painful erections or embarrassment.

Investigations

Diagnosis is confirmed by skin biopsy — not accurate if topical steroids have already been used on the lesion.

Management

Refer for expert opinion given the long-term risks of missing or mistreating the condition (SCC, anatomical change). Treatment involves potent topical steroids, often for several months, then long-term maintenance steroid 2–3 times weekly — the condition rarely fully remits. Monitor for SCC every 6–12 months. Circumcision may help if there’s an inadequate response to medical therapy.