From the Guidelines
I strongly recommend using Betamethasone cream 0.05% twice daily for 30 days to treat phimosis with preputial fibrosis, as it has been shown to be effective in improving symptoms and potentially avoiding the need for surgery. According to a prospective study of 111 boys with phimosis using betamethasone for 1 month, 80% had normal retractability of the foreskin after this time 1. To apply the cream, use a small amount and gently rub it into the tight foreskin area until absorbed, washing hands before and after application. This topical steroid works by reducing inflammation and softening the scarred tissue (fibrosis) of the foreskin, making it more elastic.
- Benefits of this treatment include:
- A non-surgical approach with minimal side effects compared to circumcision
- Potential to avoid surgery
- Improvement in symptoms
- Risks and considerations include:
- Local skin irritation
- Thinning of the skin with prolonged use
- Potential for fungal infection
- Risk of paraphimosis, a medical emergency requiring immediate attention if the foreskin gets stuck behind the glans and can't be returned to its normal position During treatment, gentle stretching exercises of the foreskin can be performed when comfortable to enhance the effectiveness of the medication. It is essential to be aware of the potential risks and to seek medical help immediately if any concerns or complications arise, such as paraphimosis, which can restrict blood flow and cause serious complications 1.
From the Research
Indication for Betamethasone Cream 0.05% BID x 30 days
- The treatment of phimosis with preputial fibrosis using betamethasone cream 0.05% BID x 30 days is indicated, as supported by studies such as 2 and 3.
- These studies demonstrate the effectiveness of topical steroid therapy in treating phimosis, with success rates ranging from 74% to 87% 2, 3.
Risk of Paraphimosis
- The risk of paraphimosis is a potential complication of phimosis treatment, as noted in study 4, which reported a 0.0098% incidence of paraphimosis.
- However, this risk is considered low, and the benefits of treatment with betamethasone cream 0.05% BID x 30 days may outweigh the risks for many patients.
Benefits of Treatment
- The benefits of treatment with betamethasone cream 0.05% BID x 30 days include the potential to avoid surgical circumcision, as well as the improvement of phimosis symptoms, as demonstrated in studies such as 2, 5, and 3.
- Topical steroid therapy has been shown to be a safe and effective treatment for phimosis, with minimal side effects reported in the literature 2, 5, 6, 3.
Applications and Instructions
- Patients should be instructed to apply the betamethasone cream 0.05% to the distal aspect of the prepuce twice daily for 30 days, as described in study 3.
- It is essential to review the indication, risk, benefits, and applications instructions with the patient and answer all their questions, as well as discuss the risk of paraphimosis and the appropriate course of action, as supported by studies such as 2, 4, and 3.