From the Guidelines
The management of lichen sclerosis on the glans penis primarily involves potent topical corticosteroids, with clobetasol propionate 0.05% ointment being the first-line treatment, as recommended by the British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018 1. The treatment approach should prioritize reducing inflammation and autoimmune activity in the affected tissue.
- Apply a thin layer of clobetasol to the affected area once daily for 1–3 months, as suggested by the guidelines 1.
- Use an emollient as a soap substitute and as a barrier preparation to maintain good hygiene and prevent further irritation.
- For cases resistant to topical steroids, consider intralesional triamcinolone in male patients with LS with topical steroid-resistant, hyperkeratotic areas following biopsy to ensure no intraepithelial neoplasia or malignancy, as recommended by the guidelines 1.
- Circumcision may be beneficial for men with persistent phimosis, as it removes the chronically inflamed tissue and prevents further scarring, and is recommended for patients who do not respond to an ultrapotent topical steroid after 1–3 months 1.
- Patients should be monitored regularly for improvement, side effects of steroid therapy, and to screen for malignant transformation, as there is a small risk of developing squamous cell carcinoma.
- The guidelines also recommend considering a repeat course of topical treatment for 1–3 months in those who relapse 1.
- Additionally, referral to a urologist may be necessary for patients with urinary symptoms due to LS, meatal involvement, or urethral stricture, as recommended by the guidelines 1.
From the Research
Management of Lichen Sclerosis on the Glans of the Penis
The management of lichen sclerosis on the glans of the penis involves various treatment options, including:
- Topical corticosteroids, such as clobetasol propionate 0.05% cream, which have been shown to be effective in reducing symptoms and improving clinical outcomes 2, 3
- Polydeoxyribonucleotide (PDRN) dermal infiltration, which has been found to have anti-inflammatory effects and improve clinical outcomes when used in combination with topical corticosteroids 4
- Other topical interventions, such as mometasone furoate 0.05% and pimecrolimus, which have also been found to be effective in treating genital lichen sclerosus 3
Treatment Outcomes and Side Effects
Treatment outcomes for lichen sclerosis on the glans of the penis include:
- Significant reduction in symptoms, such as itching, burning, and pain 2, 3
- Improvement in clinical outcomes, such as reduction in erythema and infiltration 4, 2
- Potential side effects, such as angiomatous reaction and Kaposi-sarcoma-like lesions, which have been reported with long-term use of topical corticosteroids 5
Comparison of Treatment Options
Comparisons of different treatment options for lichen sclerosis on the glans of the penis include:
- Clobetasol propionate 0.05% cream versus placebo, which found significant improvements in symptoms and clinical outcomes with clobetasol propionate 3
- Mometasone furoate 0.05% versus placebo, which found significant improvements in clinical outcomes with mometasone furoate 3
- Pimecrolimus versus clobetasol propionate, which found that pimecrolimus was less effective than clobetasol propionate in improving clinical outcomes 3