By Gary M. White, MD
Balanitis xerotica obliterans (BXO) is characterized by atrophic white patches and plaques on the penis. It is the penile equivalent of lichen sclerosus (LS). It has been proposed that micro incontinence and exposure of the skin to urine is associated [ADV 2013:93:246-8]. Some say that ￼￼the term “balanitis xerotica obliterans” should be replaced with “lichen sclerosus with phimosis.” BXO has been associated with squamous cell carcinoma [BJD 2001;145;85] and very rarely penile melanoma [JAMA Derm 2016;2152;226].
White, atrophic patches occur on the glans head, corona and shaft. Purpuric patches are not uncommon. A circumferential band may constrict the penis--so called waisting.
Clobetasol propionate cream QHS is very effective [JAAD 1999;40;451]. It relieves itch within days and improves the condition within a month. At that point, its use should be tapered to 2/week. It may obviate the need for surgical correction of phimosis in young boys. Circumcision in the uncircumcised is effective. Urine should be kept clear of the area.
In this man, the BXO spared the exposed skin. The pink area around the meatus shown here was not covered by the foreskin "at rest," whereas the white affected skin was.
Circumferential narrowing of the shaft with retraction of the foreskin, so called "waisting."
Squamous cell carcinoma developing in untreated BXO. JAAD February 2010 Volume 62, Issue 2, Pages 284–290