Lichen sclerosus (LS) is a chronic inflammatory skin disease characterised by sclerotic, pruritic lesions that primarily affect the anogenital region. LS causes significant morbidity in patients of all genders and ages. The incidence of LS in boys is not well documented, however the most common age for affected boys is 8 years (range 1–16). Routine diagnosis can be made clinically, but histological study remains crucial to rule out important differential diagnoses. Several genetic, physiological and environmental factors contribute to the pathological process seen in LS. The etiology and the precise molecular mechanisms underlying this disease are nevertheless unknown.
In boys, the lesions generally affect the foreskin and glans (balanitis xerotica obliterans, BXO), leading to phimosis and potential meatal stenosis. The main symptom in adult males is dyspareunia, resulting in a significant impact on quality of life. Complications include urinary and sexual dysfunction, genital scarring, and the development of malignant neoplastic diseases in adult life. Clinical studies indicate that 4.5-8.4% of male patients with LS will develop squamous cell carcinoma of the penis (PSCC).
Circumcision is regarded as the definitive management for BXO in boys. Studies with supplemental medical therapies such as topical steroids, immune modulators, intra-lesional triamcinolone, ozonated olive oil and carbon dioxide laser have been described in both adults and children with BXO.
Several matters relating to both the pathogenetic mechanisms and the treatment options for LS remain unresolved. This special issue aims to address the various topics that are still being debated.
Prof. Carmelo Romeo
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