Presentation
Three patients presented with retention of urine, four had difficulty in passing urine and two patients presented with painful erection. [ajol.info]
The clinical presentation and complications of lichen sclerosus are well known. What is less well known is the true incidence of the condition. [ncbi.nlm.nih.gov]
Furthermore, on histological examination BXO presents a very characteristic picture. Hyperkeratosis is present and the epidermis is atrophic with thinning of the rete pegs. Vacuolar degeneration of the basal layer may be present. [cirp.org]
Features a downloadable Online Image Collection that you can use to enhance your presentations. Presents two brand-new chapters covering urinary cytology and fine needle aspiration to keep you up to date. [books.google.es]
Hematological
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Easy Bruising
The white thin fragile areas, sometimes surrounding the foreskin in a figure of eight pattern, have a crinkly surface; their fragility may lead to easy bruising and erosions. Later on, the foreskin opening can shrink, leading to pain on intercourse. [londoncircumcisioncentre.co.uk]
Entire Body System
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Recurrent Urinary Tract Infection
This can make urination even more difficult or painful BXO can result in urethral stricture that can further cause frequent or recurrent urinary tract infections Individuals may have severe stress and anxiety issues Any attempt by the individual to forcibly [dovemed.com]
Alternative presentations include urethral stricture disease, urethral fistulation, urethral diverticula, abscesses, recurrent urinary tract infections, dyspareunia, perineal pain and lymphadenopathy. [abdominalkey.com]
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Pediatric Disease
He is an Editor-in-Chief, Journal of Pediatric Diseases, PiscoMed Publishing Ltd, and co-editor for many international journals: Advances in Bioscience and Clinical Medicine, Annals of Pediatric Surgery, Medical Journal of Case report (Bio Med), Medicine [books.google.es]
Skin
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Hemorrhagic Bullae
We noted hemorrhagic bullae in one of our cases early in the course of the disease. Carcinoma may be an eventual development, as exemplified in cases described by Stühmer, Frühwald 20 and Grütz. 5 Fig. 1. [cirp.org]
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Follicular Plugging
The presence of dells and of follicular plugging is regarded as an important diagnostic aid. [cirp.org]
Neurologic
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Paresthesia
The disease was accompanied by intense itching and disagreeable paresthesias. Delbanco stated his belief that kraurosis was a disease sui generis differing from the condition in cases of leukoplakia described by Kraus and Fuchs. [cirp.org]
circinate plaques that are often associated with white or silvery scales; usually systemic Carcinoma in situ Infectious lesions Genital herpes Primary disease: constitutional symptoms followed by genital vesicles Recurrent disease: prodromal local paresthesias [aafp.org]
Urogenital
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Penile Lesion
The management of benign penile lesions usually involves observation or topical corticosteroids; however, neoplastic lesions generally require surgery. [aafp.org]
Treatment of Penile lesion T1 G3, T 2 Partial / total amputation. Conservative strategy is an alternative in very carefully selected patients. 22. Treatment of Penile lesion Local recurrence Second conservative procedure. Partial / total amputation. [slideshare.net]
However, only 50% of these patients will have cancer in the lymph nodes as these lymph nodes are often "reactive" to inflammation or super-infection in the penile lesion. [bradyurology.blogspot.com]
Invasive tumours require staging of the primary penile lesion and inguinal and pelvic lymph nodes. Local staging can be performed using magnetic resonance imaging (MRI). [patient.info]
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Renal Insufficiency
Chronic renal insufficiency has been reported in association with BXO, but a causal relationship remains to be established. Treatment Options Potent topical corticosteroids are the mainstay of treatment. [dermatologyadvisor.com]
Workup
Imaging Metastatic workup should include CXR, bone scan, and CT scan of the abdomen and pelvis. Disseminated disease is present in less than 10% of patients at presentation. [health.am]
Serum
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Lymphocytes Increased
Later, the relative number of lymphocytes increases, and epitheloid and plasma cells may be present. In the subacute phases the lympocytic infiltrate becomes arranged about the vessels. [cirp.org]
Microbiology
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Borrelia Burgdorferi
"Possible Role of Borrelia burgdorferi Sensu Lato Infection in Lichen Sclerosus". Br J Dermatol. 144 (5): 591–598. doi : 10.1001/archderm.144.5.591. PMID 18490585. Pass, CJ (1984). [en.wikipedia.org]
Detection of Borrelia burgdorferi DNA ( B. garinii or B. afzelii ) in morphea and lichen sclerosus et atrophicus tissues of German and Japanese but not of US patients. Arch Dermatol 1997; 133 :41-4. [ Abstract ] Cantwell AR Jr. [cirp.org]
burgdorferi Candidal species - Smooth erythematous scaly papules with satellite pustules (Superadded inf) with peeling of skin /- Plaques of thrush / Maceration / Erosions Other causes (Psora/ Syphilis/ Sycosis) Candida albicans Human papilloma virus [homeopathyworldcommunity.ning.com]
Other Pathologies
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Lymphocytic Infiltrate
The classic lesion of penile LS occurs relatively late and is characterized by hyperkeratosis of the epithelium, atrophy and loss of the rete pegs, degeneration of the basal cells, sclerosis of the sub epithelial collagen and lymphocytic infiltration [urologyannals.com]
Treatment
Treatment Options Potent topical corticosteroids are the mainstay of treatment. In general, the risk of atrophy from uncontrolled disease outweighs the risk of pulse therapy with potent topical corticosteroids. [dermatologyadvisor.com]
The treatment of balanitis xerotica obliterans I. Depasquale 1, A.J. Park 1 and A. [cirp.org]
No consensus exists about the optimal approach to treatment for balanitis xerotica obliterans. Surgery (including skin grafting), a variety of pharmacologic therapies, and laser treatment have been used with varying degrees of success. [medpagetoday.com]
Unfortunately there is no definitive treatment for the condition. BXO requires specialist assessment and treatment and might require joint management from a urologist and dermatologist. [irishhealth.com]
Further treatment, or treatment of circumcised patients, is more challenging. Intraurethral steroids provide efficacious therapy for stricture disease in patients with biopsy proven BXO before invasive surgery. 4. [londoncircumcisioncentre.co.uk]
Prognosis
Submission of the foreskin for histological analysis should always be considered, as prognosis differs for lichen sclerosus vs nonlichen sclerosus histology. We recommend a care pathway for boys with lichen sclerosus. [f1000.com]
The prognosis depends upon several factors and may be guarded Who gets Balanitis Xerotica Obliterans? (Age and Sex Distribution) Balanitis Xerotica Obliterans is a condition of the penis that usually affects men in the 30-50 years age group. [dovemed.com]
References: [7] [8] Prognosis [amboss.com]
Prognosis The prognosis for urachal cancer remains poor with its insidious course and advanced disease at presentation. [abdominalkey.com]
Physical examination is of paramount importance as staging (depth of spread; see below) is most important in determining prognosis. [bradyurology.blogspot.com]
Etiology
There appears to be an increased risk for family members to develop LS, suggesting a genetic component to the etiology. General Prevention Neonatal circumcision appears to be protective. [unboundmedicine.com]
Operations on the genitals, such as circumcision and dorsal incision, are not etiologic factors in our opinion. In contradistinction to Stühmer's 2 belief that the disease occurs only in young adults, we feel that it may occur at any age. [jamanetwork.com]
Etiology: may be idiopathic or may be associated with an underlying carcinoma. [auanet.org]
Abstract Background: Balanitis Xerotic obliterans (BXO) or Penile Lichen Sclerosus is a dermatological condition affecting the genitalia and associated with chronic, progressive, sclerosing inflammatory dermatosis of unclear etiology. [ajol.info]
While the exact etiology is unclear, BXO is more common in some conditions such as hypospadias and secondary phimosis. The reported rates of BXO in children ranges from 9 - 40%. [spuonline.org]
Epidemiology
Balanitis xerotica obliterans: epidemiologic distribution in an equal access health care system. South Med J. 2003 Jan. 96(1):9-11. [Medline]. Huntley JS, Bourne MC, Munro FD, Wilson-Storey D. [emedicine.medscape.com]
Epidemiology The prevalence is 1 in 300 to 1 in 1,000 men. Peak incidence appears to be 21 to 30 years of age ( 2 ). Neonatal circumcision appears to prevent development of BXO. [unboundmedicine.com]
16060864 ) Kiss A....Merksz M. 2005 39 Heroic measures may not always be justified in extensive urethral stricture due to lichen sclerosus (balanitis xerotica obliterans). ( 15351594 ) Peterson A.C....Webster G.D. 2004 40 Balanitis xerotica obliterans: epidemiologic [malacards.org]
Epidemiology Rare type of malignancy in industrialized countries More common in developing countries in Africa, South America, and Asia Peak incidence : 60 years of age References: [1] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
Epidemiology Balanitis is more common in men than in boys. It is present in approximately 11% of attendees at genitourinary medicine (GUM) clinics. Balanitis affected 5.9% of uncircumcised boys in one study and 14% in another. Risk factors. [unityskinclinic.com]
Pathophysiology
However, circumcision later in childhood may not be protective; affects foreskin and glans in 57–100%, meatus in 4–37% with involvement of urethra in about 20% Etiology and Pathophysiology The exact cause of BXO is unknown. [unboundmedicine.com]
Etiology Pathophysiology Although the pathogenesis is unknown, HLA-subtype susceptibility and high rates of associated autoimmune disorders suggest that the disorder may be autoimmune in nature. [dermatologyadvisor.com]
AIDS Pathophysiology AIDS Transmission AIDS Treatment AIDS Prognosis History of AIDS AIDS Stigma [news-medical.net]
Pathophysiology The etiology of male genital lichen sclerosus is unknown, but it is thought to be multifactorial. Balanitis xerotica obliterans (BXO) has occurred in monozygotic twins, which suggests a genetic basis for the disease in some cases. [emedicine.medscape.com]
To get free no obligation Quote For Penile Cancer Treatment in India : click here India & International : 91 9371770341 Pathophysiology Penile cancers usually begin as small lesions on the glans or prepuce. [indiacancersurgerysite.com]
Prevention
General Prevention Neonatal circumcision appears to be protective. Early diagnosis may allow for earlier treatment to prevent anatomic changes, such as stricture, and prevent malignant change ( 1 ). [unboundmedicine.com]
The following factors may be considered towards the preventative steps for Balanitis Xerotica Obliterans: Prevent phimosis by treating any infections early and in a timely fashion Refraining from intense sexual activities or ensuring care during sexual [dovemed.com]
Treatment is aimed at the relief of symptoms and prevention of disease progression. Topical steroid therapy is the first-line ther... [5minuteconsult.com]
A hard, white ring of tissue often forms on the glans which prevents the foreskin from retracting. [medic8.com]
Awareness of the diagnosis and its typical features will enable the patient to receive the correct treatment and prevent further distressing management cul-de-sacs – such as referral to rule out sexually transmitted infection. [pulsetoday.co.uk]