This site discusses phimosis in its specific forms of phimotic ring, frenulum breve, adhesions or skinbridges. During erection these conditions inhibit the relationship between foreskin and glans. This functionally restricts the erection, and thus has an effect on the sexuality. With our culture's attitudes on health care, it would be appropriate to monitor boys before puberty and encourage early prevention.

2012 : note from author: My previous idea of monitoring boys before puberty is impractical, unecessary and now only of historical interest. please see Postscript.

updates and supporting education on new site : Phimosis.cloud

LICHEN SCLEROSUS ET ATROPHICUS (LSA)
and CLOBETASOL PROPIONATE

RS. Please note : My criticism of these studies is that parents should not be advised to experiment with steroids on children, until conclusive, scientific, unbiased, and uncontradictory studies have been performed, and the methods tried and tested, - preferably on adults. Individual adults or parents who ecstatically praise steroids as the new wonder cure will not change my attitude.

Betamethasone is occasionally claimed to cure LSA

RS criticism of LINDHAGEN:
First we will consider an excellent scientific study, noting over previous studies "However neither of these studies considered the possibility that the outcome was attributable to anything but the steroid.". Histological (i.e. the cellular strructure, by which LSA etc, is diagnosed) examinations were performed.

T. LINDHAGEN
Topical clobetasol propionate compared with placebo in the treatment of unretractable foreskin.
Eur J Surg 1996 Dec;162(12):969-72

ABSTRACT: Objective: To assess whether it is the steroid alone or the gentle physical retraction combined with ointment that is responsible for the excellent results observed with topical steroid treatment of unretractable foreskin. Design: Prospective, randomised, double-blind study. Setting: University hospital, Sweden. Subjects: 30 Boys randomised to be treated with clobetasol propionate (n = 15) or placebo (n = 15). Interventions: The boys were examined 1, 2 and 6 months, respectively, after treatment. Main Outcome Measures: Comparison between the effects of clobetasol propionate and placebo. Results: Two patients in the steroid group and one in the placebo group withdrew from the study. 10 Boys in the steroid group showed an improvement within 2 months. The remaining 3 boys had no effect and were circumcised. Histopathological examination showed lichen sclerosus et atrophicus. Seven boys in the placebo group improved. The 7 non- responders were prescribed clobetasol propionate ointment, and all 7 improved. Conclusion: 17 of 27 boys referred with "phimosis" were successfully treated with an ointment and gentle traction. When clobetasol propionate was given the non-responders success rate was increased to 24/27 (89%).

ADDED EXTRACTS
" .. clobetasol propionate 0.05% (Dermovate, Glaxco UK). Instructions were to retract the foreskin as much as possible without causing pain and then apply a thin layer of the ointment into the prepuce from the corona gkandis to the distal margin once daily. After one week of treatment, gentle attempts to retract the foreskin should be made.
The problem remains, however, to differentiate and operate on the cases with lichen schlerosus et atrophicus, a distinct histopathological diagnosis which leads to fibrotic scarring of the distal prepuce with true phimosis, and which may develop into squamous cell carcinoma.
In recent years topical steroid ointments have been successfully used to treat phimosis. Jørgensen and Svensson reported a 70% rate of success using clobetasol propionate 0.05% cream, while Kirikos et. al. had an overall success rate of 81% with different regimens including betamethasone and hydrocortisone creams. However neither of these studies considered the possibility that the outcome was attributable to anything but the steroid."
The dilemma facing the family practitioner and the paediatrician is one of differential diagnosis, and identifying the cases of lichen sclerosus et atrophicus. The development of phimosis in previously retractable foreskin has been suggested as a criterion ... A good practice could be to circumcise patients with more than two recurrencese after treatment with topical steroid.
In conclusion, the non-invasive treatment of phimosis with an ointment and gentle traction resolves half the cases, and this increases to almost 90% with the addition of a potent topical steroid, thereby significantly reducing the "need" for circumcision."


RS criticism of DAHLMAN-GHOZLAND:
An excellent study, (both this and the previous come from Sweden). clobetasol propionate needs further study - because both studies are completely contradictory - the first says clobetasol propionate does not relieve LSA, the second says it does, and both are 100% conclusive. (above: 3 circumcised had LSA - below: "All histologic LSA criteria were significantly (P < .01 to .05) reduced after treatment.")

K DAHLMAN-GHOZLAND, Hedblad MA, von Krogh G
Penile lichen sclerosus et atrophicus treated with clobetasol dipropionate 0.05% cream: a retrospective clinical and histopathological study.
Department of Dermatovenereology, Karolinska Hospital, Stockholm, Sweden.
J Am Acad Dermatol 1999 Mar;40(3):451-7

Abstract: BACKGROUND: Treatment with clobetasol propionate 0.05% cream is effective against lichen sclerosus et atrophicus (LSA) of the vulva. OBJECTIVE: The purpose of this study was to retrospectively evaluate whether clinical and histologic responses to topical clobetasol can be accomplished in penile LSA. METHODS: A self-assessment questionnaire was obtained from 22 men with LSA, and a clinical examination was performed in 21 of them. Biopsy specimens from 15 cases were compared before and after treatment. RESULTS: Itching, burning, pain, dyspareunia, phimosis, and dysuria decreased significantly (P < .001 to .05) after 1 to 2 daily applications, for a mean of 7.1 weeks (2-16 weeks). Additional operation for phimosis was required in 6 of the 22 men. All histologic LSA criteria were significantly (P < .01 to .05) reduced after treatment. CONCLUSION: Topical treatment of penile LSA with clobetasol propionate represents a safe and effective therapy with no risk of epidermal atrophy but with some potential for triggering latent infections, most importantly human papillomavirus.