OVERVIEW

What is balanitis xerotica obliterans?

Balanitis xerotica obliterans, also known as penile atrophy, is a disease of unclear etiology. It is essentially a condition called lichen sclerosus that occurs on the male external genitalia (glans penis, foreskin).

Its main characteristic is progressively worsening sclerotic atrophy of the glans penis and foreskin. Currently, there is no specific treatment for this condition.

Is balanitis xerotica obliterans common?

The incidence of this disease is relatively low, and there are few reported cases in China.

Is balanitis xerotica obliterans contagious?

The disease is not contagious, and normal sexual activity is possible. However, if it is complicated by conditions such as fungal infections of the glans, it is recommended to use condoms during intercourse to reduce irritation to the glans.

Which groups are commonly affected by balanitis xerotica obliterans, and where does it occur?

• The disease is more common in individuals with phimosis or recurrent balanitis, particularly men aged 15–50.

• The most commonly affected areas are those covered by excess foreskin (inner foreskin, coronal sulcus, glans penis, urethral meatus). It may also spread to the penile shaft and even the scrotum.

SYMPTOMS

What are the manifestations of xerotic obliterative balanitis?

1. The typical symptom is the appearance of annular white sclerosis at the distal foreskin, which may involve the glans, foreskin, and coronal sulcus.
2. In the early stages or mild cases, patients often experience no discomfort or pain, possibly presenting only as erythematous spots or well-defined purplish-white plaques, rarely involving the frenulum, urethral orifice, and navicular fossa.
3. When the condition severely affects the external urethral orifice, leading to significant narrowing, symptoms such as dysuria and difficulty urinating may occur.
4. If the disease severely invades the frenulum of the foreskin, it may cause atrophy or even disappearance of the frenulum.
5. Some patients may also experience atrophy of the glans.

CAUSES

What causes xerotic obliterative balanitis?

The exact cause is currently unclear. Since the condition primarily occurs in individuals with phimosis or redundant prepuce, it is believed to be mainly related to these factors. However, some suggest it may be associated with recurrent balanitis (infectious factors), while others propose possible links to autoimmune or genetic factors. All these possibilities require further clarification.

DIAGNOSIS

What tests are needed for balanitis xerotica obliterans?

The diagnosis mainly relies on physical examination and pathological examination:

• Physical examination: Early manifestations are atypical. The naked eye may observe redness and thickening of the foreskin, accompanied by pink papules that feel soft to the touch (similar to touching lips or a sponge-like sensation). Sometimes, surface scaling may be visible.
  As the disease progresses, the manifestations become more typical. The papules gradually change from pink to porcelain-white or ivory in color, with skin atrophy and thinning. Parchment-like folds may appear, and the texture hardens upon touch, losing the sponge-like sensation.

• Pathological examination: Early-stage balanitis xerotica obliterans is characterized by moderate lymphocyte infiltration in the superficial dermis and basal epidermal cells, accompanied by vacuolar changes in the basal epidermal cells. As the disease advances, elastic fibers in the papillary dermis are lost, the epidermis atrophies, and hyperkeratosis of the skin occurs.

TREATMENT

Which department should be visited for dry obliterative balanitis?

Generally, dermatology should be consulted first. If complications such as urethral meatus stenosis occur, urology should be visited.

How should dry obliterative balanitis be treated?

There is no specific treatment for this condition. The main approaches include:

• Medication: Oral vitamin E; topical corticosteroid ointments (used cautiously in patients with skin atrophy).

• Surgical treatment: Urethral dilation for meatal stenosis; foreskin release or circumcision for phimosis or foreskin adhesion.

Can untreated dry obliterative balanitis lead to cancer?

Dry obliterative balanitis is currently considered a precancerous condition with a certain potential to develop into malignancy. The incidence is low, and studies suggest a 4%–8% probability of progression to malignancy. However, the disease progresses rapidly once it occurs.

Can dry obliterative balanitis be completely cured?

The disease causes skin lesions, and there is currently no definitive cure. Treatment focuses on symptom management, so complete recovery is currently unattainable.

DIET & LIFESTYLE

What should patients with balanitis xerotica obliterans pay attention to in daily life?

• Actively treat the underlying conditions that may cause the disease;

• Regularly clean the foreskin and glans;

• Seek specialized treatment promptly if complications such as urethral stricture occur.

PREVENTION

How to prevent dry obliterative balanitis?

• Early circumcision reduces the incidence of the disease, so it is recommended for those with phimosis or redundant prepuce;

• Regularly retract and clean the foreskin, but ensure it is repositioned after cleaning;

• Protect the glans and avoid trauma to it as much as possible;

• Actively treat infections of the glans. During infection, abstain from sexual activity or use condoms to prevent mutual transmission between partners, which may hinder complete recovery.