Clinical findings:
(1) It is a chronic and insidious disease of the glans and prepuce that usually occurs in uncircumcised males.
(2) Initially there are small erythematous areas that progress to whitish plaques that coalesce.
(3) The prepuce becomes thickened and fibrotic, eventually becoming fixed over the glans.
(4) Fissures and erosions may develop.
Biopsy shows a histologic progression identical to lichen sclerosus et atrophicus:
(1) Early there is a dermal lymphocytic infiltrate.
(2) Diffuse eosinophilic fibrosis develops (sclerosus), with flattening of the epidermal basal layer (atrophicus) and hyperkeratosis.
(3) Fully developed lesions show a thinned epithelial layer overlying a densely fibrotic submucosa.
Complications:
(1) meatal stenosis, urethral narrowing, or urethral stricture
(2) phimosis
(3) dysplasia of the glans progressing through carcinoma
Management:
(1) topical corticosteroids
(2) excision of small lesions
(3) circumcision
(4) meatotomy or meatoplasty
(5) urethroplasty with nongenital skin for strictures
