Skip to main content
SpringerLink
Log in

Die topische Therapie der Balanitis xerotica obliterans im Kindesalter

Klinische Langzeitergebnisse und Übersicht

Topical therapy of balanitis xerotica obliterans in childhood

Long-term clinical results and an overview

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Die Balanitis xerotica obliterans (BXO) ist eine chronisch entzündliche progressive Hauterkrankung unklarer Ätiologie und Inzidenz, deren Management im Kindesalter umstritten ist. Wenngleich meist nur die Vorhaut befallen ist, können bei meataler oder urethraler Lokalisation auch im Kindesalter komplexe Rekonstruktionen notwendig sein. Empfohlen wird die möglichst komplette chirurgische Entfernung der befallenen Hautpartien. Bei meatalem Befall, histologischem Zufallsbefund, Rezidiv oder unmöglicher Komplettentfernung sollte eine topische Therapie eingesetzt werden. In einer retrospektiven Analyse war in unserem Krankengut (n=13) die Rezidivrate nach topischer Therapie mit Tacrolimus (Protopic®), einem hochselektiven Immunmodulator, geringer als nach antientzündlicher Standardtherapie mit Betamethason. Tacrolimus-Salbe (Protopic®) stellt eine sichere und nebenwirkungsfreie Therapie dar. Da es keine prädiktiven Faktoren für einen Progress oder ein Rezidiv der BXO gibt, ist aus unserer Erfahrung eine topische antientzündliche Nachbehandlung immer indiziert. Der anschließende Follow-up sollte engmaschig sein, um Rezidive frühzeitig erkennen und therapieren zu können.

Abstract

Balanitis xerotica obliterans (BXO) is a chronic and progressive dermatitis of unknown aetiology and incidence. Its management in childhood is controversial. Although in most cases only the prepuce is affected, meatal and urethral involvement may lead to major surgical reconstruction. Therefore complete surgical excision of the affected skin is considered to be mandatory. In case of involvement, incidental histological evidence or a relapse, or when complete removal of the affected skin is not possible, a topical therapy should be implemented. In a retrospective analysis of our study population (13 children) with BXO, relapse rate was lower after topical therapy with tacrolimus (Protopic®), a highly selective immune modulator, than after the standard anti-inflammatory therapy with betamethasone. The use of tacrolimus ointment is a safe therapy with no severe side effects. Due to the fact that there are no predictive factors for progression or relapse of BXO, we consider a topical anti-inflammatory therapy is always indicated after any type of surgery for BXO. Follow-up monitoring should be close, so that any relapse can be detected and treated as early as possible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Bale PM, Lochhead A, Martin HCO, Gollow I (1987) Balanitis xerotica obliterans in children. Pediatr Pathol 7: 617–627

    Article  PubMed  CAS  Google Scholar 

  2. Böhm M, Frieling U, Luger A, Bonsmann G (2003) Successful treatment of anogenital Lichen sclerosus with topical tacrolimus. Arch Dermatol 139: 922–924

    Article  PubMed  Google Scholar 

  3. Cabaleiro P, Drut RM, Drut R (2000) Lymphohistiocytic and granulomatous phlebitis in penile lichen sclerosus. Am J Dermatopathol 22: 316–320

    Article  PubMed  CAS  Google Scholar 

  4. Clemmensen OJ, Krogh J, Petri M (1988) The histologic spectrum of prepuces from patients with phimosis. Am J Dermatopathol 10: 104–108

    Article  PubMed  CAS  Google Scholar 

  5. Clifton MM, Garner IB, Kohler S, Smoller BR (1999) Immunohistochemical evaluation of androgen receptors in genital and extragenital lichen sclerosus: Evidence for loss of androgen receptors in lesional epidermis. J Am Acad Dermatol 41: 43–46

    Article  PubMed  CAS  Google Scholar 

  6. Das S, Tunuguntla HS (2000) Balanitis xerotica obliterans – a review. World J Urol 18: 382–387

    Article  PubMed  CAS  Google Scholar 

  7. Depasquale I, Park AJ, Bracka A (2000) The treatment of balanitis xerotica obliterans. BJU Int 86: 459–464

    Article  PubMed  CAS  Google Scholar 

  8. Fischer G, Rogers M (1997) Treatment of childhood vulvar lichen sclerosus with potent topical corticosteroid. Pediatr Dermatol 14: 235–238

    PubMed  CAS  Google Scholar 

  9. Garat JM, Chechile G, Algaba F, Santaularia JM (1986) Balanitis xerotica obliterans in children. J Urol 136: 436–437

    PubMed  CAS  Google Scholar 

  10. Gargollo PC, Kozakewich HP, Bauer SB et al. (2005) Balanitis xerotica obliterans in boys. J Urol 174: 1409–1412

    Article  PubMed  Google Scholar 

  11. Hennge UR, Krause W, Hofmann H et al. (2006) Multicentre, phase II trial on safety and efficacy of topical tacrolimus oinment for the treatment of lichen sclerosus. Br J Dermatol 155: 1021–1028

    Article  CAS  Google Scholar 

  12. Herschorn S, Colapinto V (1979) Balanitis xerotica obliterans involving anterior urethra. Urology 14: 592–596

    Article  PubMed  CAS  Google Scholar 

  13. Mattioli G, Repetto P, Carlini C et al. (2002) Lichen sclerosus et atrophicus in children with phimosis and hypospadias. Pediatr Surg Int 18: 273–275

    Article  PubMed  CAS  Google Scholar 

  14. McLelland J (2004) Lichen sclerosus in children. J Obstet Gynaecol 24: 733–735

    Article  PubMed  Google Scholar 

  15. Meffert JJ, Davis BM, Grimwood RE (1995) Lichen sclerosus. J Am Acad Dermatol 32: 393–416

    Article  PubMed  CAS  Google Scholar 

  16. Pietrzak P, Hadway P, Corbishley CM, Watkin NA (2006) Is the association between balanitis xerotica obliterans and penile carcinoma underestimated? BJU Int 98: 74–76

    Article  PubMed  Google Scholar 

  17. Poynter JH, Levy J (1967) Balanitis xerotica obliterans: effective treatment with topical and sublesional corticosteroids. BJU Int 39: 420–425

    Article  CAS  Google Scholar 

  18. Powell J, Wojnarowska F, Winsey S et al. (2000) Lichen sclerosus premenarche: autoimmunity and immunogenetics. Br J Dermatol 142: 481–484

    Article  PubMed  CAS  Google Scholar 

  19. Produktmonographie (2002) Protopic© Tacrolimussalbe 0,03%/0,1%. Dermatology, München

  20. Rallis E, Korfitis C, Gregoriou S et al. (2007) Assigning new roles to topical tacrolimus. 16: 1267–1276

  21. Staff WG (1970) Urethral involvement in Balanitis xerotica obliterans. BJU Int 47: 234–239

    Google Scholar 

  22. Stühmer A (1928) Balanitis xerotica obliterans (post operationem) und ihre Beziehung zur Kraurosis glandis et praeputii penis. Arch Derm Syph 156: 613–623

    Article  Google Scholar 

Download references

Interessenkonflikt

Keine Angaben

Author information

Authors and Affiliations

  1. Abteilung für Kinderurologie der Universität Regensburg, Klinik St. Hedwig, Steinmetzstraße 1–3, 93049, Regensburg, Deutschland

    A.-K. Ebert & W.H. Rösch

  2. Dermatologische Universitätsklinik , Regensburg, Deutschland

    T. Vogt

Authors
  1. A.-K. Ebert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Vogt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W.H. Rösch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A.-K. Ebert.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ebert, AK., Vogt, T. & Rösch, W. Die topische Therapie der Balanitis xerotica obliterans im Kindesalter. Urologe 46, 1682–1686 (2007). https://doi.org/10.1007/s00120-007-1577-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-007-1577-1

Schlüsselwörter

Keywords

Search

Navigation