The response of balanitis xerotica obliterans to local steroid applicationcompared with placebo in children

Purpose: We evaluated the clinical effectiveness of topical steroid applica tion for balanitis xerotica obliterans in children and analyzed the associa tion of any clinical response with histological findings. Materials and Methods: Our double-blind, placebo controlled, randomized stu dy included 40 boys in whom balanitis xerotica obliterans was diagnosed cli nically by cicatricial phimosis. The severity of phimosis was graded into 4 groups. Patients were randomized to receive the topical application of 0.0 5% mometasone furoate or placebo. After 5 weeks phimosis severity was reeva luated and all patients underwent circumcision. Surgical specimens were his tologically typed as an early, intermediate or late form of balanitis xerot ica obliterans. Results: Seven patients were withdrawn from the study. In the steroid group 7 boys had clinical improvement and 10 had no change. Histological study s howed an early, intermediate and late form of balanitis xerotica obliterans in 5, 5 and 7 cases, respectively. Of cases with clinical improvement 5 we re the early and 2 the intermediate type. In the placebo group 5 cases wors ened clinically and 11 did not change. Histological evaluation revealed an early, intermediate and late form of balanitis xerotica obliterans in 3, 7 and 6 boys, respectively. Of the 5 cases with histological worsening, disea se was the early, intermediate and late type in 2, 2 and 1, respectively. Conclusions: Applying a potent topical steroid affects improvement in balan itis xerotica obliterans in the histologically early and intermediate stage s of disease, and may inhibit further worsening in the late stage.