Treatment of Penile Adhesions
For penile adhesions, apply topical clobetasol propionate 0.05% ointment if the underlying disease (particularly lichen sclerosus) is still active, followed by manual lysis of adhesions and daily foreskin retraction with petroleum jelly application for at least 3 weeks to prevent recurrence. 1
Initial Medical Management
Topical steroid therapy is the cornerstone of initial treatment:
- Apply clobetasol propionate 0.05% ointment to active disease areas, particularly around the coronal sulcus, to prevent Koebnerization (new lesion formation at sites of trauma) and further scarring 1
- This is especially critical in lichen sclerosus-associated adhesions, which require aggressive topical steroid treatment 1
Monitor for infectious complications:
- Watch for increased redness, warmth, purulent discharge, or fever indicating secondary infection 1
- These signs necessitate prompt antibiotic therapy in addition to topical steroids
Post-Lysis Care Protocol
After adhesion separation (whether spontaneous or surgical), strict adherence to the following regimen prevents re-adhesion:
- Daily foreskin retraction for minimum 3 weeks - this is non-negotiable for preventing recurrence 1
- Apply white soft paraffin (petroleum jelly) every 4 hours to maintain moisture and reduce friction between healing surfaces 1
- If disease remains active post-procedure, continue topical steroid application to prevent Koebnerization at the surgical site 1
Surgical Intervention Criteria
Circumcision is indicated when:
- Phimosis persists despite adequate medical management with topical steroids 1
- Subcoronal or transcoronal adhesions fail to resolve with medical treatment 1
- There is concern for malignant transformation (lichen sclerosus carries 2-9% risk of penile carcinoma) - biopsy should be performed if malignancy is suspected 1
Critical Pitfalls to Avoid
Do not attempt adhesion lysis without addressing active inflammation first - separating adhesions in the presence of active lichen sclerosus or other inflammatory conditions will result in immediate re-adhesion through Koebnerization 1
Do not neglect the post-separation retraction protocol - failure to perform daily retraction for at least 3 weeks is the most common cause of recurrent adhesions 1
Do not dismiss long-standing lichen sclerosus - these patients require ongoing surveillance for malignant transformation given the 2-9% carcinoma risk 1