Phimosis cream and ointments with steroids: when are they effective?

Phimosis cream and ointments with steroids: when are they effective?

Phimosis cream and ointments with steroids: when are they effective?
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Using phimosis cream is one of the recommended methods prior to resorting to circumcision surgery in cases of juvenile congenital phimosis. This therapy intervenes, above all, where a phimotic ring has not yet formed, that is, where no “loop” of inelastic cells is yet present, and its effects depend on the type of phimosis and the patient’s personal response.

In cases of congenital phimosis the problem of the foreskin gliding over the glans is due to the lack of foreskin growth which prevents normal coverage of the glans. In acquired phimosis, with interventions in adulthood, on the other hand, after an infection, there is the occurrence of a ring of inelastic cells that creates a loop on the foreskin.

Although we always refer simply to ‘phimosis’, these two clinical situations are very different.

The difference between steroidal and non-steroidal cream

The effect of steroidal cream for phimosis is to generate an anti-fibrotic and anti-inflammatory action on the skin of the foreskin, so as to facilitate uncovering the glans’ again.

From the analyses carried out, it seems that the local application of a cream with steroids makes the skin thinner and thus reduces the inflammatory component. In some ways it is this “side effect” that makes it useful for treating juvenile congenital phimosis, and not for other skin diseases.

There are those who believe applying a simple ointment to the penis, with combined foreskin exercises will help resolve the problem. This theory, however, has been denied by numerous research studies, which have analysed the treatment of phimosis with a placebo (non-steroidal) ointment, but have shown few comforting results (fewer than 20% positives).

Phimosis Cream: only for juvenile congenital phimosis

The published scientific data about phimosis cream are always linked to research on juvenile, congenital phimosis.

It is important to emphasise this aspect in detail, because phimosis at a young age is vastly different to that in adulthood (the same congenital phimosis changes with the passing of the years).

The international scientific research study ” The response of phimosis to local steroid application” by CS Kikiros, SW Beasley, and AA Woodward at the Department of General Surgery, Royal Children’s Hospital in Australia, analysed the effect of phimosis ointment treatments (three different types) applied to a juvenile cohort (up to 16 years) with varying degrees of congenital phimosis. The conclusion of the group analysis was that local application of a steroid ointment to the foreskin produced resolution of juvenile congenital phimosis in over 60% of cases, but if the foreskin had a circumferential white scar (phimotic ring), this was less likely to respond to treatment. After cessation of the cream with steroids, the phimosis developed again in a percentage of patients.

Success or failure of treatment with phimosis cream depends on:

  • the patient’s age (validating data only on patients under the age of 16)
  • type and severity of phimosis (only on congenital phimosis, at a young age)
  • correct application of the ointment
  • compliance with the treatment
  • the method of application

In some cases, the retractability of the foreskin may decrease after a few months, and further applications of steroid ointments are therefore recommended. Correct serum glucose control is important in patients with diabetes.

The aforementioned data are also present in other publications:

  1. Pless TK., Spjeldnaes N., Jorgensen TM. Topical steroid in the treatment of phimosis in children. Ugeskr Laeger, 1999;
  2. Jorgensen ET., Svensson A. The treatment of phimosis in boys, with a potent topical steroid (clobetasol propionate 0.05%) cream. Acta Derm Venereal, 1993;
  3. Golubovic Z., Milanovic D., Vukadinovic V., Rakic I. and Perovic S. The conservative treatment of phimosis in boys. Br J Urology, 1996;
  4. Atilla MK. et al. A non-surgical approach to the treatment of phimosis: local non-steroidal anti-inflammatory application. J of Urology, 1997;
  5. Van Howe RS. Cost-effective treatment of Phimosis. Paediatrics 1998
  6. Rickwood Am., Walter J. Is phimosis over-diagnosed in boys? Ann R Coll Surg Engl, 1989.

A treatment with steroid ointment can, therefore, help in the case of congenital phimosis in children. And for adults?

For adults, the issue changes – and rather a lot.

Phimosis in adults: what is the right treatment?

As we have repeatedly emphasised, most of the research about phimosis cream is carried out on a young public, where phimosis is often in its initial state and is mostly congenital (i.e. where there is no phimotic ring caused by pre-putial inflammation and scarring ). For adults, given the different type of phimosis (largely acquired) and the mature state of the penis, doctors often suggest circumcision straight away.

Phimostop instead, can be the right alternative to phimosis surgery.

At its base, Phimostop has a solid principle (the natural capacity of epidermal tissue to change as a result of ongoing progressive expansions) and a European patent (plus a Gold Medal award from the International Exhibition of Inventions), not to mention validation by the Italian Ministry of Health, all of which confirm its validity.

Compared to therapy with creams and ointments, Phimostop offers a device that intervenes in depth on phimosis, freeing the foreskin from the phimotic ring, with healing times that are often much faster (10 days for medium phimosis, but with subjective variations).

Phimostop acts on the inelastic cells of the phimotic tissue by making them thinner and stimulating the creation of new elastic cells and is the only device for treating phimosis that has been validated by the Italian Ministry of Health, included in Class 1 and is available for purchase in pharmacies without the need for a prescription.

Its ease of use allows you to wear the device during the day and/or night, without limiting daily activities, including sports. Finally, the tuboids allow you to consolidate the result obtained and, after adequate washing, can be used again in time in rare cases where there are recurrences.