KUMJ | VOL. 24 | NO. 2 | ISSUE 95 | APRIL - JUNE, 2026

Lichen sclerosus amongst Prepubertal Nepalese Boys with Phimosis: A Prospective Observational Study
Shrestha AL, Ali S, Mishra A, Yadav B, Acharya L, Niraula S

Abstract:
Background Lichen sclerosus (Ls), a chronic lymphocyte-mediated scarring dermatosis of possibly autoimmune origin typically affects the foreskin and glans penis in boys. With an elusive etiology and multifactorial causation, it has an incidence that is globally variable. Nevertheless, a resultant genital discoloration and recurrent balanoposthitis can seriously impact urinary functions in boys in addition to the risks of malignancy. Early identification is imperative for successful control and prevention of complications. Objective To study the profile of Nepalese boys with phimosis, determine the prevalence of Lichen sclerosus and assess the outcomes of treatment modalities. Method A prospective observational study was performed in boys who underwent treatment for phimosis between 1st September 2024 to 28th February 2026. Demographical profile, clinical findings, surgical details and outcomes were studied. Result A total of 200 boys were evaluated for symptomatic non-retractable foreskins at a mean age of 8 years (range: 4-16 years) and a mean symptom duration of 17 months. Of them, 139 were clinically diagnosed to have Physiological Phimosis (PhP) with most of them categorized as Kikiro’s Grade I-II. They underwent Foreskin Adhesiolysis (FA) as a conservative treatment along with local application of ultra potent steroid cream for 2 months and foreskin hygiene maintenance thereafter. At the end of 3 months, they all had complete resolution of symptoms and no recurrence. The remaining 61 were diagnosed to have Pathological Phimosis (PaP) with most of them categorized as Kikiro’s Grade III-IV and underwent Sleeve circumcision. Of them, 33 had histological evidence of lichen sclerosus while the rest 28 had non-specific chronic inflammation (non-Ls). The overall prevalence of lichen sclerosus was found to be 16.5% (33/200). Boys with lichen sclerosus were also treated with steroid cream as an adjuvant therapy for 2 months and followed up for a median period of 10 months while the rest (non-Ls) were followed up without adjuvant treatment. No serious complications were noted. Conclusion A vast majority of Nepalese boys (69.5%) with symptomatic phimosis were responsive to conservative measures with only a third needing operative management. Of these, lichen sclerosus was the underlying pathological cause in 16.5%.
Keyword : Balanitis xerotica obliterans, Circumcision, Lichen sclerosus, Phimosis