From the Guidelines
The recommended treatment for phimosis is conservative management with gentle retraction during bathing and topical steroid cream, such as betamethasone 0.05% or mometasone 0.1%, applied to the tight phimotic ring twice daily for 4-8 weeks, as this approach has been shown to be effective in reducing symptoms and improving outcomes, as supported by the British Association of Dermatologists' guidelines for the management of lichen sclerosus, 2018 1.
Key Considerations
- The severity of phimosis and the patient's age should guide the treatment approach.
- Conservative management is preferred for mild cases, while surgical options, such as circumcision or preputioplasty, may be necessary for moderate to severe cases that do not respond to conservative treatment.
- Topical steroid cream can reduce inflammation and soften the skin, allowing for easier stretching and improvement of symptoms.
- Proper hygiene is essential during treatment to prevent complications, and patients should be advised that improvement with topical steroids may take several weeks to become noticeable.
Treatment Failure
- If treatment with topical corticosteroids appears to fail, it is essential to consider noncompliance, incorrect diagnosis, or additional superimposed problems, such as contact allergy or urinary incontinence, as highlighted in the British Association of Dermatologists' guidelines for the management of lichen sclerosus, 2018 1.
- Patients with hyperkeratotic LS may require further treatment and should be referred to a specialist clinic, where systemic retinoids may be considered.
Surgical Options
- Circumcision may be necessary for patients with tight phimosis who do not respond to conservative treatment, as it can allow for the application of topical steroids to the diseased inner aspect of the foreskin, as noted in the British Association of Dermatologists' guidelines for the management of lichen sclerosus, 2018 1.
- Preputioplasty, a less invasive procedure that widens the tight foreskin without removing it, may be an alternative to circumcision for some patients.
From the Research
Phimosis Treatment Options
- Phimosis is a condition where the foreskin cannot be fully retracted over the glans penis, and it can be treated with various methods.
- The recommended treatment for phimosis includes topical steroid therapy, which has been shown to be effective in several studies 2, 3, 4, 5, 6.
Topical Steroid Therapy
- Topical steroid therapy involves applying a steroid cream to the foreskin to help loosen and retract it.
- Studies have shown that topical steroid therapy can be an effective treatment for phimosis, with success rates ranging from 65.8% to 95% 2, 3, 4, 5, 6.
- The treatment typically involves applying the steroid cream twice a day for several weeks, and the response to treatment can be seen as early as 1 week 5.
Comparison with Circumcision
- Circumcision is a traditional treatment for phimosis, but topical steroid therapy can be a safer and less invasive alternative.
- Studies have compared the effectiveness of topical steroid therapy with circumcision, and the results suggest that topical steroid therapy can be a good alternative to surgery in some cases 2, 4.
Factors Affecting Treatment Outcome
- The success of topical steroid therapy can depend on various factors, such as the severity of the phimosis, the age of the patient, and the presence of scarring or other conditions 3, 4.
- Daily retraction and cleansing of the foreskin can also help prevent recurrence of phimosis and improve treatment outcomes 3.