What is lichen sclerosis?
Lichen sclerosis in men, also known as balanitis xerotica obliterans (or BXO), is a skin disorder characterised by white patches on the head and foreskin of the penis.
Lichen sclerosis affects around 1 in 250-1000 boys (average age of 7 years) and up to around 1 in 1000 men.

Symptoms of lichen sclerosis
If you have lichen sclerosis, you might not have any symptoms, or you might experience:
• Altered sensation in your penis
• Itchiness
• Pain during urination.
Usually, the end of the foreskin is white and hardened, which can lead to phimosis or paraphimosis.

Causes of lichen sclerosis
Lichen sclerosis is usually caused by long-term irritation and inflammation of the foreskin and head of the penis. Over time, the irritation and inflammation can lead to accumulation of scar tissue1.
Like balanitis and balanoposthitis, lichen sclerosis occurs more commonly in males who are uncircumcised. This suggests that the collection of skin secretions and cells (smegma) between the foreskin and the head of the penis can lead to the irritation and inflammation that start the disease.
In uncircumcised males, urine can become trapped between the foreskin and head of the penis, which may also lead to skin irritation.
Lichen sclerosis is associated with obesity, smoking and cardiovascular disease. There may also be a genetic component to the risk of lichen sclerosis.

Diagnosis of lichen sclerosis
Lichen sclerosis is usually diagnosed based on the appearance of your foreskin3. If circumcision is required, the diagnosis may be confirmed by examining the foreskin in a laboratory after surgery.

Treatment of lichen sclerosis
Treatment of lichen sclerosis usually involves the application of steroid cream for two to three months. If this doesn’t improve or cure your lichen sclerosis, you may need a biopsy to help with further diagnosis.
Circumcision may be necessary if your lichen sclerosis results in phimosis or paraphimosis.

Health effects of lichen sclerosis
Lichen sclerosis rarely goes away on its own. If untreated, lichen sclerosis can get worse and cause phimosis, paraphimosis, painful erections and urinary problems that usually require surgery.
Lichen sclerosis is associated with an increased risk of penis cancer, which develops in 4-8% of men who have the disease.
A yearly review by your doctor will be necessary to keep an eye on whether your lichen sclerosis returns or progresses.

What to do about lichen sclerosis
The appearance of white, hardened areas of skin on your foreskin or the head of the penis needs to be assessed by your doctor. If lichen sclerosis is ignored, you can develop serious complications that will affect your sexual and urinary function, and your health more widely.

This content is modified from Healthy Male: healthymale.org.au. This information has been provided for educational purposes only. It is not intended to take the place of a clinical diagnosis or proper medical advice from a fully qualified health professional. Healthy Male and International Society of Andrology both urge readers to seek the services of a qualified medical practitioner for any personal health concerns.

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