![]() ![]() 4, 10 The other significant long-term complication associated with penile LS is penile squamous cell carcinoma (SCC). It is important to achieve disease control in penile LS not only for relief of symptoms for the patient, but also to prevent long-term sequelae from chronically active disease such as irreversible phimosis and meatal stenosis which may require potential surgery. 7 It is essential that prescribing clinicians are aware of these implications and especially when more potent/lipophilic corticosteroids are used long term. 9 This is in keeping with the inversely proportional relationship between systemic absorption of topical medications and thickness of the stratum corneum. 7 Regional variation in systemic absorption of topical corticosteroids is important to consider with the genital region demonstrating up to 40 fold higher absorption rates over the more studied region of the forearm. Although uncommon, important systemic adverse effects of Cushing’s syndrome, bone osteopathy and adrenocortical suppression have been documented from cutaneous use of topical corticosteroids. 8 Therefore, caution must be taken before interpreting any examination findings as solely iatrogenic.ĭecades of both in vitro and in vivo studies have acknowledged potential for systemic absorption of topical corticosteroids. ![]() 3, 4 Furthermore, epidermal atrophy and telangiectasia have both been demonstrated to improve in patients with vulval LS treated with topical clobetasol, with data lacking in penile LS. 7 However, telangiectasia and epidermal atrophy can also be a sign of chronic penile LS, independent of corticosteroid use. 2, 5, 6 Reported potential adverse cutaneous side effects observed from topical corticosteroids on non-genital skin include erythema, telangiectasia, purpura and striae. 3įamily practitioners and pharmacists appear to hold particular concern in relationship to epidermal atrophy seen with long-term use of topical corticosteroids such as in atopic dermatitis as well as genital use. 3, 4 LS is likely under-diagnosed as observed in a large case series due to a complex interplay of psychosocial factors leading to delay in diagnosis as in this case. 3 Although LS may be diagnosed clinically, histology is often useful to exclude differential diagnoses such as irritant dermatitis (“non-specific balanitis”), lichen planus, allergic contact dermatitis, psoriasis and penile intraepithelial neoplasia. Similar to our case patient, uncircumcised men are particularly at risk of LS. 3 Painful erections were likely caused by mild phimosis, with balanitis/glans inflammation contributing to dyspareunia. Symptoms experienced by our case patient such as burning dysesthesia and erythema of the glans/shaft of penis are typical of LS. The erythema of the glans penis was felt to be secondary to chronic use of his topical corticosteroid preparations over 25 years, rather than a feature of active penile LS. ![]() There was no definite evidence of active LS. Examination revealed diffuse erythema of the glans penis, minor adhesions of the lateral aspect of the glans penis across the coronal sulcus, some telangiectasia, mild swelling of the foreskin but no phimosis, erosions or ulcers (see Figures 1 and and2). When seen in our clinic, the patient only reported recurrent ulcers of his glans penis associated with mild dyspareunia. His family doctor changed therapy to mometasone furoate 0.1% ointment (60 g/year) for the next 10 years after fear of adverse effects from long-term use of betamethasone dipropionate 0.05% ointment. The patient self-managed his penile LS with betamethasone dipropionate 0.05% ointment for 15 years (30 g/year) and topical lidocaine gel, achieving symptomatic relief while lost to follow-up. This came after multiple specialist involvement including urologists and general physicians. Biopsy histopathology demonstrated compact hyperkeratosis, oedematous collagen in superficial papillary dermis and prominent and dilated superficial vessels with light lymphocytic infiltrate. After 8 years, the patient was diagnosed with penile LS with histological confirmation on skin biopsy by a dermatologist. Infectious causes such as herpes and sexually transmitted infections were ruled out by swab testing and clinical correlation. The pain and dysesthesia severely disrupted the patient’s quality of life, restricting ability to work and limiting sexual intercourse leaving the patient depressed. At this time, the patient was 22 years of age describing severe dysesthesia of the glans penis and concurrent swelling of distal foreskin. The patient’s symptoms first occurred 36 years prior to review. A 58-year-old uncircumcised male was referred for LS of the glans penis to a male genital dermatology clinic. ![]()
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