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Re: The dreaded BXO

Written by Rood at 19 Apr 2003 05:47:33:

As an answer to: The dreaded BXO written by Paul B. at 18 Apr 2003 11:30:59:

Thank you. I've been wanting educated and thoughtful comments on these assertions. It only seems strange that there is so much confusion, particularly among doctors, regarding a condition which too often leads to distress among those afflicted and hence to unnecessary circumcision. Cannot the truth be distributed to all dermatologists and urologists in the form of a simple memo? Or is there dissention in the ranks?

I had considered mentioning this possibility.
>> What you have "might" be BXO, or Balanitis xerotica obliterans (also called lichen sclerosus et atrophicus, or LSA).
>My friendly dermatologist tells me "BXO" is a deprecated term. It is "LSA affecting the foreskin" - and is treated as such.
>> To an experienced dermatologist there is no mistaking BXO ... but a diagnosis must be confirmed by a biopsy.
>That's an interesting contradiction there, Rood! You can't have it both ways. It might be a little more accurate to say that an experienced dermatologist would have a high degree of suspicion as to what was or was not LSA, but would perform the biopsy to make sure as it certainly influences the treatment program.
>My friendly dermatologist (and indeed all competent ones) goes to great pains to explain that a biopsy of skin is frequently useless in formulating a diagnosis because the pathologist cannot identify a disease, only confirm whether the appearance is consistent with a proposed diagnosis - the clinician has to supply the diagnosis to be matched and if he suggests the wrong one, that may still match!
>> Surgical removal is almost never necessary.
>Surgical removal is predicated on the concept that the disease - LSA - is a form of infection or "rot" which must like cancer, be removed with a surrounding "clean" area to stop "spread". It is probably unclear to what extent - if at all - this is true of LSA. Since it is an auto-immune disorder, there might be a place for removing the tissue where the damage is occurring to reduce the activation of the immune system, but again, this is contentious.
>The other reason for removing organs, is to remove a source of risk for malfunction or infection, so that for example, parts of the thyroid (also subject to auto-immune disease) are removed because of physical obstruction to the larynx (windpipe) or toxicity from over-production of thyroxine. In the case of the foreskin however, the harm that BXO causes is by scarring and shrinkage of the affected tissue, so removing it all is a somewhat perverse approach as you say! Surely, none is functionally worse than too little!
>> BXO can usually be successfully cured with steroid cream, carbon dioxide laser treatment, or even antibiotics.
>Mostly steroid cream. COČ laser is really a variant of surgery.
>> Females with BXO never have their labia amputated, nor is the glans of a circumcised person with BXO amputated.
>Actually, I must correct you on both these points, insofar as surgeons not uncommonly perform both these procedures (on the corresponding patients!). Indeed, it is one "accepted" exception to the laws prohibiting FGM. Not to say that I would accept it as competent practice ...


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