Medical Q&As

Balanitis xerotica obliterans - what is it?

Can you tell me about “lichen sclerosis et atrophicus” and “balanitis xerotica obliterans”? My husband has been diagnosed with this and I would like to know the possible causes and possible results of having this.

Your husband’s diagnosis is a very good example of how medical terminology can sometimes be quite mystifying for non-medical people. Lichen sclerosus refers to a chronic inflammatory condition of the skin that mainly affects the vulval and perineal area. BXO (balanitis xerotica obliterans) is the term used to describe this condition when it affects the male genitalia. The cause of the condition is not known but there is an association with other auto-immune conditions such as vitiligo and certain forms of thyroid disease. It is extremely important to emphasise that the condition is not transmissible through sexual intercourse and is not infectious; neither can it be acquired through sexual intercourse. The condition is chronic and progressive and can lead to permanent changes in the glans penis and foreskin which can give rise to stricture formation or narrowing of the urethra. These skin changes are characterised by the formation of a hard white lump around the opening of the urethra. A reddened area then forms around the lump and a chronic process of inflammation and scarring ensues which can sometimes lead to ulcer formation. The affected area can become itchy and sore. Unfortunately there is no definitive treatment for the condition. BXO requires specialist assessment and treatment and might require joint management from a urologist and dermatologist. In some cases steroid creams might be helpful, while others benefit from retinoid creams which are also used in the treatment of acne. Circumcision has also been used to treat the condition and in some cases has been curative especially in the absence of stricture formation in the urethra. The logic behind that particular treatment is that the moist environment of the glans and foreskin facilitates the development of the disease and by removing the foreskin the glans has an opportunity to dry out. Your husband might find it helpful to contact a British support group for this condition. The URL for their website is: http://www.lichensclerosus.org/.