From the Guidelines
Phimosis is primarily caused by inflammation or scarring of the foreskin, which prevents it from retracting properly over the glans penis, with lichen sclerosus being a significant contributing factor, as evidenced by the British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018 1. The causes of phimosis can be multifaceted, including:
- Poor hygiene leading to recurrent infections
- Balanitis (inflammation of the glans)
- Balanoposthitis (inflammation of both glans and foreskin)
- Skin conditions like lichen sclerosus, which can lead to scarring and tightening of the foreskin, as noted in the guidelines for the management of lichen sclerosus, 2010 1
- Trauma to the foreskin, including forced retraction or injury, can lead to scarring and pathologic phimosis
- Diabetes can contribute to phimosis due to increased risk of infections and poor healing
- Rarely, phimosis may result from sexually transmitted infections or skin cancer affecting the foreskin
- Genetic factors may also play a role in some cases, as certain individuals may be predisposed to developing tighter foreskin or conditions that affect skin elasticity It is essential to consider these causes to develop proper prevention and treatment approaches, including the use of topical corticosteroids, as recommended in the British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018 1, and circumcision in cases where topical treatment fails, as suggested in the guidelines for the management of lichen sclerosus, 2010 1 and the Journal of Urology, 2007 1. In cases where treatment with topical corticosteroids appears to fail, it is crucial to consider noncompliance, incorrect diagnosis, and additional superimposed problems, such as contact allergy or urinary incontinence, as outlined in the British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018 1. The most effective approach to managing phimosis involves a comprehensive evaluation of the underlying causes and the use of evidence-based treatments, such as topical corticosteroids and circumcision, as supported by the highest quality studies, including the British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018 1.
From the Research
Causes of Phimosis
The provided studies do not directly address the causes of phimosis. However, they discuss the treatment and management of the condition.
Treatment and Management
- Topical corticosteroids have been shown to be an effective treatment for phimosis in boys, with a significant increase in complete or partial clinical resolution of the condition 2, 3, 4, 5, 6.
- The use of topical corticosteroids such as betamethasone and triamcinolone has been reported to have a success rate of 69.4% to 76% in treating phimosis 2, 3, 4.
- A systematic review of 14 studies found that topical corticosteroids may increase the complete resolution of phimosis after four to eight weeks of treatment, with low-certainty evidence 6.
- The review also found that topical corticosteroids may increase the partial resolution of phimosis at four to eight weeks of treatment, with low-certainty evidence 6.
Types of Phimosis
- The studies do not provide a clear classification of the types of phimosis, but they do mention that the condition can be physiological or pathological 4.
- The degree of phimosis has been found to be a factor in the success of treatment, with more severe cases being less likely to respond to topical corticosteroids 3.