[ ARC forum 2 ]
Written by Robin at 27 Sep 2000 17:42:47: dermatologists - steroids
Hello anyone and everyone,
I was recently thinking we should be sending people to dermatologists - "skin doctors" We`re not talking about internal things (in which the urologist is very well versed) - these are skin conditions and maldevelopments, dermatologists are the specialists for methods and ointments which will stretch skin --- Besides which they regularly have to deal with VD problems balanitis etc. so they`re probably far more used to looking at foreskins than urologists are
I`d even encourage someone with frenulum breve to think about getting to see a dermatologist - there`s probably ointments which will thin the frenulum enough to enable a natural stretch or rip ... perhaps needs testing by someone with just a mild degree - (extreme forms of phimosis and frenulum are just going to take longer for the creams to get through).
Thinking as well that if you want the best surgery you go to a surgeon ... pretty good stuff really - anyway it changes my previous recommendation of going to urologists - urologists are good for complicated internal things - but dermatologists are the doctors for skin complaints ...
My latest information on skin creams is a convincing study, - unfortunately on a very small sample, but Lindhagen just has - to me - a clearly unbiased realistic approach ... we dont want kids with LSA wasting their time amd getting frustrated using creams
greetings from the garden
Robin __________Lindhagen T - 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%).
EXTRA QUOTES
.. clobetasol propionate 0.05% (Dermovate, Glaxco UK). Instructions were to retract the foreskin as much as possible without causing paiun 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 recurrences 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.