Our approach to the treatment of Balanitis Xerotica Oliterans (BXO) is aimed at eliminating occlusive contact of skin to urine, minimising urinary and sexual morbidity, abolishing the risk of progression to penile squamous cell carcinoma (PSCC) (by curing the inflammatory and scarring disease), with preservation of the foreskin if possible  If the condition is diagnosed early and interventions instituted promptly, disease progression and morbidity can be halted, and normality can be restored. Our medical treatment protocol involves avoidance of contact with urine by assiduously emptying the urethra after micturition (by shaking, squeezing, dabbing, and using barrier preparations), regular use of soap substitutes and barrier emollient creams and application of ultrapotent topical corticosteroids for a fixed, monitored period of time (usually clobetasol propionate). In addition, the short trimming of pubic hair is recommended in order to eliminate penile abrasion, irritation and inflammation. We avoid using topical calcineurin inhibitors due to the theoretical link with progression to SCC, but accept that this is controversial in BXO The mainstay of surgical management is circumcision.

If the above medical treatment regiment fails then circumcision is offered. Some patients may require further urethromeatal surgery. The success rates with medical therapy previously reported in the literature by us and others are in the range of 50-60%, whereas circumcision is thought to lead to cure in >75% of patients. Our results confirm the above; in isolated BXO, 50% of patients were treated successfully with medical therapy and foreskin preservation. The validity of the above treatment protocol is vindicated further by the outcomes of this study, with 91.7% having achieved resolution of symptoms, and the remaining either receiving ongoing medical therapy (4.8%) or waiting to undergo circumcision (3.5%). Side effects were minimal and mainly related to surgery.

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Journal of the European Academy of Dermatology and Venereology, Version of Record online: 16 AUG 2017