Clinical and histological predictors of disease severity in boys with lichen sclerosus: a prospective multicentre observational study

Abstract

Background: lichen sclerosus is an inflammatory dermatosis resulting in progressive phimosis and meatal stenosis. Following circumcision, a proportion of boys require further interventions to manage ongoing symptoms. We investigated whether clinical or histopathological disease severity associated with persistent symptoms or need for further interventions after circumcision.

Method: a prospective observational study was undertaken at three paediatric surgery centres in the United Kingdom. Boys aged ≤16 years undergoing surgery for suspected lichen sclerosus were included and followed-up for one year. Disease appearance was graded using pre-defined criteria during surgery. Histological disease severity in resected foreskins was reported. Ongoing symptoms and subsequent interventions were recorded. The primary outcome was the requirement for further surgery.

Results: ninety-three boys were included. Median age at surgery was 9.5 years (interquartile range: 7.4–11.8). Lichen sclerosus was confirmed histologically in 82/86 (95 %). Further surgery after circumcision occurred in 6/93 (6 %). Clinical features of disease at surgery and histopathological severity were not associated with further surgery. At follow-up 18/93 (19 %) reported symptoms, this was more common in boys requiring an emergency circumcision (6/75 [8 %] versus 5/18 [28 %], p = 0.034). Boys with meatal involvement were more likely to receive medical or surgical treatments (18/75 [24 %] versus 9/18 [50 %], p = 0.042).

Conclusions: emergency presentation and involvement of the urethral meatus at circumcision associate with ongoing symptoms after circumcision. In this cohort, the appearance of disease at surgery and the severity of disease on histopathology did not correlate with outcome. However further studies are required to validate the value of histological staging.

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ORCID for Nigel J. Hall: orcid.org/0000-0001-8570-9374

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