Lichen Sclerosus-Induced Phimosis: causes, correlation, and treatments

Version 1 – Lichen sclerosus represents one of the leading causes of acquired phimosis in adult men today. This chronic inflammatory dermatological condition causes progressive changes in the structure of the preputial skin, making it increasingly rigid, fragile, and less elastic. The result is often the development of phimosis that can manifest rapidly even in men who previously had no problems.

The relationship between lichen sclerosus and phimosis is particularly important to understand because it significantly influences the therapeutic approach. While phimosis of other origins can often be treated with conservative methods, that caused by lichen sclerosus requires specific strategies and more careful monitoring over time, given that this disease can progress and, in rare cases, increase the risk of developing skin malignancies.

Version 2 – Lichen sclerosus stands as one of the most significant—yet often misunderstood—causes of acquired phimosis in adult men. This isn’t just another skin condition; it’s a progressive inflammatory disorder that transforms healthy, flexible preputial tissue into rigid, fragile skin that can no longer function normally.

What makes lichen sclerosus particularly insidious is its ability to strike without warning. Men who have never experienced any genital problems can suddenly find their foreskin tightening, becoming painful, and developing the characteristic white, shiny patches that signal this condition’s presence. Unlike congenital phimosis or simple scarring, lichen sclerosus represents a fundamentally different challenge that demands a completely different approach.

General characteristics of Lichen Sclerosus-Induced Phimosis

Lichen sclerosus (LS) is one of the causes of acquired phimosis in adults. This chronic inflammatory dermatological condition predominantly affects genital skin, causing progressive structural alterations that can lead to severe preputial stenosis.

There are several signs that may suggest phimosis is caused by lichen sclerosus:

• The foreskin presents a whitish or pearlescent colour
• The skin appears shiny, thin, and fragile
• There may be small scars or lesions present
• The problem developed rapidly
• There is itching or burning sensation in the area

It is essential to identify whether phimosis is caused by lichen sclerosus because this significantly influences the type of treatment. While “simple” phimosis can often be treated with conservative methods, that caused by lichen sclerosus usually requires a more specific approach and closer medical monitoring over time.

Additionally, although rare, lichen sclerosus can slightly increase the risk of developing skin tumours in the affected area, making regular monitoring important.

It should be noted that phimosis can manifest from various etiologies, not necessarily related to the presence of lichen sclerosus. In cases where preputial stenosis presents as a congenital condition or is acquired from causes other than lichen sclerosus (such as post-inflammatory cicatricial processes, local trauma, or connective tissue alterations), conservative therapeutic approaches may represent a valid alternative to surgical correction.

In such circumstances, medical devices specifically designed for non-invasive treatment of phimosis, such as the Phimostop devices, may be considered within a gradual and controlled therapeutic protocol, under specialized medical supervision, to achieve progressive preputial dilation and restoration of normal anatomical function.

Consequences and complications of Lichen Sclerosus-Induced Phimosis

If lichen sclerosus is not recognized and treated promptly, it can lead to serious consequences that go well beyond simple discomfort and, in some situations, can lead to the development of phimosis.

It is important to understand these risks deeply to motivate those who suffer from it to seek timely medical help:

• Permanent anatomical changes: the disease can cause irreversible modifications to genital form and function. In men, the foreskin can become so tight that it can no longer move, while the urethral opening can narrow, making normal urination difficult.
• Sexual problems: pain during intercourse, loss of sensitivity, and anatomical changes can seriously compromise sexual life. This affects not only the affected person but also their partner and the couple’s relationship.
• Recurrent infections: damaged skin is more vulnerable to bacterial and fungal infections, which can become a chronic problem that is difficult to resolve.
• Urinary difficulties: when the disease involves the urethra, it can cause problems such as a weak urinary stream, difficulty completely emptying the bladder, and in severe cases, may require surgical interventions to reopen the urinary passage.
• Malignancy risk: although rare (occurring in less than 5% of cases), lichen sclerosus can increase the risk of developing skin cancer in the affected area. This risk increases with age and if the disease is not kept under control.

Psychological impact: living with chronic pain, sexual problems, and changes in genital appearance can cause anxiety, depression, loss of self-esteem, and difficulties in interpersonal relationships. Many people become socially isolated or avoid intimacy due to fear or embarrassment.

Treatment Options for Lichen Sclerosus-Induced Phimosis

Several effective treatments exist for lichen sclerosus before it progresses to phimosis. Although there is no definitive cure that eliminates the disease, it is possible to control it very well and significantly improve quality of life.

Surgical treatment

When pharmacological treatment is not effective or the disease is already in an advanced state, surgical intervention may be necessary. In men, the most common operation is circumcision, which involves removing the diseased foreskin.

Treatment of lichen sclerosus affecting the glans involves two main types of circumcision:

• Partial circumcision: only the most damaged part of the foreskin is removed, leaving the glans partially covered. This intervention is less invasive but may have a higher risk of recurrence.
• Complete circumcision: the entire foreskin is removed, leaving the glans completely exposed. This intervention has more lasting results and a success rate approaching nearly 100%.

The choice between the two depends on how extensive the disease is and patient preferences after discussing the pros and cons of each option with the physician.

Laser therapy is an option that helps “repair” scars and damaged areas. Initial improvements are usually seen after 15 days from treatment, and the procedure can be repeated if necessary.

In more complex cases, when the disease has also involved the glans or urethra, more sophisticated reconstruction interventions may be necessary, using healthy skin grafts taken from other parts of the body.

Alternatives to surgery

For those who prefer to avoid surgery or for less severe cases, several alternatives exist that are showing promising results.

When lichen sclerosus has caused phimosis, it is important to know that Phimostop, while being a medical device approved by the Ministry of Health for non-surgical treatment of phimosis, has limitations in these specific cases. The presence of lichen sclerosus prevents complete healing of phimosis, as the underlying dermatological condition persists. However, Phimostop can help alleviate symptoms and improve the situation, but cannot completely eliminate phimosis when it is caused by lichen sclerosus. In these cases, it is essential to simultaneously treat the dermatological condition with specific therapies prescribed by a dermatologist or urologist to achieve the best possible results.

Alternatively, among non-surgical treatments for phimosis, there is also treatment with autologous adipose tissue (lipofilling), an innovative technique where fat is harvested from areas such as the abdomen or thighs and injected into areas affected by lichen sclerosus. This fat contains cells that can help regenerate damaged tissues. The procedure lasts about 30 minutes, can be performed under local anaesthesia, and patients can return home the same day.

The results of this treatment are encouraging: most patients notice improved skin elasticity within 3 months, and the benefit is maintained for over a year in 90% of cases. Additionally, pain and itching often disappear completely.

Some physicians also use immunomodulatory drugs, which act on the immune system more specifically than cortisone, reducing the risk of side effects in long-term treatments.

Conclusions

Lichen sclerosus is a serious disease that must be managed before it leads to phimosis: the key to success is early diagnosis and appropriate treatment. If recognized in time, it can be effectively controlled, allowing people to maintain a good quality of life.

The current therapeutic landscape offers various treatment options, from conventional topical therapies to innovative regenerative medicine methodologies.

It is essential to remember that lichen sclerosus requires regular monitoring over time, even when symptoms improve. This allows for early detection of any worsening or, in rare cases, the development of malignancies.