From the Guidelines
Phimosis in infants typically doesn't require treatment until after age 3-4 years, as it's normal for the foreskin to be non-retractable in newborns and young children. Treatment should only be initiated if there are complications such as recurrent infections, difficulty urinating, or ballooning of the foreskin during urination. When treatment is necessary, it usually begins with gentle, non-forceful retraction during bathing and topical steroid cream application, as supported by the British Association of Dermatologists' guidelines 1. According to a study published in the British Journal of Dermatology, a prospective study using betamethasone for 1 month documented that 80% of boys with phimosis had normal retractability of the foreskin after this time 1. Some key points to consider when treating phimosis in infants include:
- Topical steroid cream application (0.05% betamethasone valerate or 0.1% triamcinolone) applied to the tight foreskin twice daily for 4-8 weeks can help soften and stretch the tissue, with success rates of 70-90% 1.
- Parents should never forcibly retract an infant's foreskin as this can cause scarring and worsen the condition.
- Surgical options like circumcision or preputioplasty are reserved for cases that don't respond to conservative treatment or have severe complications, as recommended by the British Association of Dermatologists' guidelines 1. This conservative approach is recommended because physiologic phimosis resolves naturally in most boys as they grow, with 90% having retractable foreskin by age 3 and 99% by adolescence.
From the Research
Treatment of Phimosis in Infants
- The treatment of phimosis in infants can begin with topical steroid therapy, as evidenced by a study published in 2002 2, which found that 74% of boys with phimosis had fully retractable foreskins after 1 month of treatment with 0.05% betamethasone cream.
- Another study published in 1996 3 found that topical steroid therapy was effective in treating phimosis in boys older than 3 years, but also suggested that an early operation may be necessary in cases of genuine phimosis when 1 month of treatment with topical steroids has failed.
- A prospective randomized study published in 2005 4 compared the effects of highly potent and moderately potent topical steroids in treating pediatric phimosis and found that both were effective in all age groups, with response rates of 81.3% and 77.4%, respectively.
Age of Treatment
- A study published in 1999 5 found that topical steroid treatment of phimosis in boys was effective in over 95% of cases, and suggested that treatment can begin at any age, including infancy.
- Another study published in 2008 6 found that spontaneous prepuce retraction is achieved in 80% of cases of boys up to the age of two, and that medical treatment may be necessary after the age of two.
Treatment Options
- Topical steroid therapy is a simple and safe method for the treatment of phimosis in infants and children, as evidenced by several studies 2, 3, 4, 5.
- In some cases, surgical treatment may be necessary, especially in cases of genuine phimosis when topical steroid therapy has failed 3, 6.
- Gentle retraction and hygiene may also be effective in treating phimosis, especially in cases where the foreskin is not severely narrowed 5.