From the Guidelines
To treat phimosis in adults, I recommend a combination of gentle stretching exercises and a topical steroid such as Betaderm (betamethasone valerate 0.1%), which is available in Canada. Apply a small amount of the steroid cream to the tight portion of the foreskin twice daily for 4-6 weeks. After applying the cream, gently retract the foreskin to the point of mild discomfort (not pain) and hold for 1-2 minutes, repeating this stretching exercise 2-3 times daily. Maintain good hygiene by cleaning under the foreskin with warm water during showers. The topical steroid works by reducing inflammation and increasing skin elasticity, making stretching more effective, as supported by the British Association of Dermatologists' guidelines 1. If no improvement occurs after 6 weeks of consistent treatment, or if phimosis is severe and causing pain, urinary problems, or recurrent infections, consult a urologist as circumcision may be necessary, as recommended by the guidelines 1. Avoid forceful retraction as this can cause tears and scarring, potentially worsening the condition. This conservative approach resolves approximately 70-90% of adult phimosis cases without the need for surgery, with studies showing significant improvement in discomfort and skin tightness, and also in urinary flow 1. Key points to consider when treating phimosis in adults include:
- Gentle stretching exercises to improve skin elasticity
- Topical steroid application to reduce inflammation
- Maintenance of good hygiene to prevent infection
- Avoidance of forceful retraction to prevent scarring
- Consideration of circumcision if conservative treatment fails, as recommended by the British Association of Dermatologists' guidelines 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION: Apply a thin film of Betamethasone Valerate Cream or Ointment to the affected skin areas one to three times a day. To treat phymosis in adults, a topical steroid can be used.
- A Canadian topical steroid option is betamethasone valerate.
- The recommended application is a thin film, applied one to three times a day 2.
From the Research
Treatment of Phimosis in Adults
- Phimosis is a condition where the foreskin cannot be completely retracted, and its treatment varies depending on the age of the patient and the severity of the disease 3.
- Conservative treatment options are available, including topical steroid application and the use of medical silicon tubes for gentle prepuce dilation 3.
Topical Steroids for Phimosis
- Topical corticosteroids have been shown to be effective in treating phimosis in boys, with studies demonstrating significant improvements in complete or partial clinical resolution of phimosis compared to placebo 4, 5.
- Betamethasone valerate is a commonly used topical steroid for treating phimosis, and it has been found to be effective in various studies 4, 6, 7.
- A Canadian topical steroid that can be used to treat phimosis is betamethasone valerate, which is available in various strengths, including 0.1% and 0.2% 6.
Treatment Regimens
- Different treatment regimens have been compared in studies, including twice-daily and thrice-daily applications of topical betamethasone, with similar efficacy and safety profiles 7.
- The choice of treatment regimen may depend on individual patient factors and preferences, and it is essential to consult with a healthcare professional to determine the best course of treatment.