Clinical parameters in male genital lichen sclerosus: a case series of 329 patients

TLDR

Male genital lichen sclerosus has received little attention, with unclear sexual morbidity, histology, treatment, prognosis, and pathogenesis, and uncertain roles for autoimmunity and HPV. The study aims to clarify these clinical parameters by analyzing a large series of patients. Retrospective review of 329 clinically diagnosed MGLSc patients from a dermatology‑centered multidisciplinary setting, with clinical and histopathological data extracted and summarized using descriptive statistics. MGLSc predominantly affects uncircumcised men, peaks in the late fourth decade, presents commonly with dyspareunia, and is effectively managed by ultrapotent topical steroids (50–60%) or circumcision (>75%), reducing penile squamous cell carcinoma risk; urinary contact appears pathogenic, while HPV and autoimmunity are not significant.

Abstract

Abstract Background The dermatological aspects of male genital lichen sclerosus (MGLSc) have not received much prominence in the literature. Sexual morbidity appears under‐appreciated, the role of histology is unclear, the relative places of topical medical treatment and circumcision are not established, the prognosis for sexual function, urinary function and penis cancer is uncertain and the pathogenesis has not been specifically studied although autoimmunity (as in women) and HPV infection have been mooted. Objective To illuminate the above by analysing the clinical parameters of a large series of patients with MGLSc. Methods A total of 329 patients with a clinical diagnosis of MGLSc were identified retrospectively from a dermatology‐centred multidisciplinary setting. Their clinical and histopathological features and outcomes have been abstracted from the records and analysed by simple descriptive statistics. Results The collation and analysis of clinical data derived from the largest series of men with MGLSc ever studied from a dermatological perspective has been achieved. These data allow the conclusions below to be drawn. Conclusions MGLSc is unequivocally a disease of the uncircumcised male; the adult peak is late in the fourth decade; dyspareunia is a common presenting complaint; non‐specific histology requires careful interpretation; most men are either cured by topical treatment with ultrapotent steroid (50–60%) or by circumcision (>75%); effective and definitive management appears to abrogate the risk of developing penile squamous cell carcinoma; urinary contact is implicated in the pathogenesis of MGLSc; HPV infection and autoimmunity seem unimportant.