Effect of topical steroid on non-retractile prepubertal foreskin by a prospective, randomized, double-blind study

Objective: The present study, conducted in Hong Kong, aimed to evaluate the effect of topical steroid in non-retractile prepubertal foreskin by a pros pective, randomized, double-blind design. Material and methods: 137 boys wi th non-retractile foreskin were randomized to betamethasone (n = 66) or pla cebo (n = 71) for 4 weeks with application of the cream twice daily. Non-re sponders to treatment were offered steroid treatment for a further 4 weeks. Results. The mean pretreatment grade of the foreskin in the steroid and co ntrol groups was 5.08 +/- 0.66 and 4.97 +/- 0.70, respectively. At the 4-we ek follow-up, 49 of the former (74%) had a retractile foreskin (grade less than or equal to 3, mean 2.38 +/- 1.41). In contrast, only 31 of the contro l group (44%) had a retractile foreskin (less than or equal to 3, mean 3.55 +/- 1.55) (p < 0.001). Only 14 boys were circumcised because 43 of the rem aining 57 boys had a retractile foreskin after 4 weeks of treatment. Conclu sion: when treatment is necessary, application of topical steroid as a firs t line of treatment may avoid surgery in almost 90% of cases.