Lichen sclerosus should be treated with corticosteroids to reduce need for surgery

EDITOR,—We wish to make several comments about Mark Davenport's article on problems with the penis and prepuce in children.1 We would argue that the term balanitis xerotica obliterans should be avoided and lichen sclerosus used instead. This is because the disease can be localised to different parts of the body—for example, on the genitals of both sexes.2 The cause of lichen sclerosus is unknown, and there is no good evidence of an infectious aetiology.

Lichen sclerosus can be treated with potent corticosteroids locally, with good results in both men and women.3 Phimosis in boys can be treated with a potent topical steroid, which thus reduces the need for surgery.4 Surgery on the prepuce may be indicated in some boys with lichen sclerosus, but even in these cases it may be wise to use a potent topical steroid after surgery to prevent recurrence and to treat any lesions on the glans penis and in the urethral orifice. Opinions vary on the value of preputial stretching since it may worsen the phimosis.5