Clinical Appearance of Lichen Sclerosus on the Penis
Lichen sclerosus on the penis presents as grayish-white or porcelain-white discoloration and plaques affecting the glans, foreskin, and frenulum, with progression leading to thinned, inelastic skin prone to fissuring, phimosis, and potential meatal stenosis. 1
Early Disease Manifestations
In early stages, the disease may be subtle with limited findings: 1
- Small amounts of perimeatal skin discoloration may be the only visible indication of lichen sclerosus
- Grayish-white discoloration appears on the glans or prepuce initially
- The affected skin begins to show subtle textural changes before more obvious plaques develop
Progressive Disease Features
As the disease advances, more characteristic findings emerge: 1
- White plaques develop on the foreskin, glans, and frenulum with a distinctive appearance
- Thinned, atrophic skin that becomes increasingly fragile over time
- Fissures and tears occur, particularly during sexual activity due to skin inelasticity
- Severe phimosis develops from progressive scarring and tightening of the foreskin
- Nonretractile foreskin results from disease progression on the frenulum and prepuce
Anatomical Distribution
The disease follows a predictable pattern of involvement: 1
- Foreskin and glans are affected in 57% of cases
- Meatus is involved in 4% of cases
- Urethral involvement occurs in 20% of patients, though it typically starts at the meatus
- Perianal region is NOT affected in males, unlike in females—this is an important distinguishing feature
Associated Complications
The chronic inflammatory process leads to functional impairment: 1
- Meatal stenosis from perimeatal scarring
- Urethral stricture disease along the pendulous urethra in advanced cases
- Poor urinary stream and dysuria from obstructive changes
- Erectile dysfunction and painful erections from skin tightening and inelasticity
Key Diagnostic Pitfalls
Important caveat: The disease can resemble other conditions, requiring careful differentiation: 1
- May mimic erythroplasia of Queyrat, lichen planus, leukoplakia, or scleroderma
- Biopsy is essential before treatment to confirm diagnosis and rule out squamous cell carcinoma 2
- The pale, shaggy appearance on urethroscopy shows sharp demarcation of disease extent 1
Malignancy Risk
Critical consideration: There is a 4-5% risk of progression to squamous cell carcinoma, with histological evidence of lichen sclerosus found in approximately 40% of penile carcinoma specimens. 1, 2, 3 This underscores the importance of recognizing the condition early and maintaining long-term surveillance for non-healing lesions or changing appearance.