Korean J Urol.  2013 Sep;54(9):624-630.

Effect of Topical Steroid (0.05% Clobetasol Propionate) Treatment in Children With Severe Phimosis

• Lee CH
• Lee SD

Abstract

PURPOSE
We report our experience with the use of a topical steroid, 0.05% clobetasol propionate, for the treatment of phimosis with clinical complications.
MATERIALS AND METHODS
This was a retrospective analysis of the clinical outcomes of all patients presenting with phimosis to a single institution during the time period from October 2008 to May 2012. A total of 88 patients who had a Kikiros retractability grade of 4 or 5 and phimosis-associated clinical complications, such as ballooning of the prepuce, balanoposthitis, or a history of urinary tract infection (UTI), were instructed to apply 0.05% clobetasol propionate cream to the slightly retracted foreskin and to massage gently while retracting the foreskin. The efficacy of treatment was evaluated at 4 weeks from the initiation of therapy.
RESULTS
A total of 60 of the 88 patients (68.2%) showed a complete response (i.e., full retraction of the foreskin) to the therapy. The phimotic ring disappeared in 25 of the 88 patients (28.4%) after treatment. Patients who had a history of balanoposthitis, smegma, ballooning of the prepuce, or UTI showed significantly poorer improvement in preputial retraction (p<0.001, p<0.001, p<0.001, and p=0.02, respectively) and phimotic ring disappearance (p<0.001, p=0.001, p<0.001, and p=0.001, respectively) after treatment. No significant local or systemic side effects were associated with the administration of topical steroids.
CONCLUSIONS
Topical application of 0.05% clobetasol propionate cream and skin stretching is a safe, simple, and effective procedure with no significant side effects for severe phimosis in prepubertal boys.

Keyword

Circumcision; Phimosis; Steroids

MeSH Terms

Child
Circumcision, Male
Clobetasol
Foreskin
Humans
Male
Massage
Phimosis
Retrospective Studies
Skin
Smegma
Steroids
Urinary Tract Infections
Clobetasol
Steroids

Reference

1. Ashfield JE, Nickel KR, Siemens DR, MacNeily AE, Nickel JC. Treatment of phimosis with topical steroids in 194 children. J Urol. 2003; 169:1106–1108.

2. Kuehhas FE, Miernik A, Sevcenco S, Tosev G, Weibl P, Schoenthaler M, et al. Predictive power of objectivation of phimosis grade on outcomes of topical 0.1% betamethasone treatment of phimosis. Urology. 2012; 80:412–416.

3. Gairdner D. The fate of the foreskin, a study of circumcision. Br Med J. 1949; 2:1433–1437.

4. Deibert GA. The separation of the prepuce in the human penis. Anat Rec. 1933; 57:387–399.

5. Monsour MA, Rabinovitch HH, Dean GE. Medical management of phimosis in children: our experience with topical steroids. J Urol. 1999; 162(3 Pt 2):1162–1164.

6. Shim YH, Lee JW, Lee SJ. The risk factors of recurrent urinary tract infection in infants with normal urinary systems. Pediatr Nephrol. 2009; 24:309–312.

7. Schoen EJ, Colby CJ, Ray GT. Newborn circumcision decreases incidence and costs of urinary tract infections during the first year of life. Pediatrics. 2000; 105(4 Pt 1):789–793.

8. Pinto K. Circumcision controversies. Pediatr Clin North Am. 2012; 59:977–986.

9. Miernik A, Hager S, Frankenschmidt A. Complete removal of the foreskin-why? Urol Int. 2011; 86:383–387.

10. Kikiros CS, Beasley SW, Woodward AA. The response of phimosis to local steroid application. Pediatr Surg Int. 1993; 8:329–332.

11. Orsola A, Caffaratti J, Garat JM. Conservative treatment of phimosis in children using a topical steroid. Urology. 2000; 56:307–310.

12. Wright JE. The treatment of childhood phimosis with topical steroid. Aust N Z J Surg. 1994; 64:327–328.

13. Jørgensen ET, Svensson A. The treatment of phimosis in boys, with a potent topical steroid (clobetasol propionate 0.05%) cream. Acta Derm Venereol. 1993; 73:55–56.

14. de Oliveira Pileggi F, Vicente YA. Phimotic ring topical corticoid cream (0.1% mometasone furoate) treatment in children. J Pediatr Surg. 2007; 42:1749–1752.

15. Zavras N, Christianakis E, Mpourikas D, Ereikat K. Conservative treatment of phimosis with fluticasone proprionate 0.05%: a clinical study in 1185 boys. J Pediatr Urol. 2009; 5:181–185.

16. Zampieri N, Corroppolo M, Zuin V, Bianchi S, Camoglio FS. Phimosis and topical steroids: new clinical findings. Pediatr Surg Int. 2007; 23:331–335.

17. Sabino Borges LG, Perez-Boscollo AC, Rocha LP, Silva RC, Guimaraes CS, Castro EC, et al. Foreskin analysis of circumcised boys with and without previous topical corticosteroid. Fetal Pediatr Pathol. 2012; 31:265–272.

18. Barnes PJ. Anti-inflammatory actions of glucocorticoids: molecular mechanisms. Clin Sci (Lond). 1998; 94:557–572.

19. Kragballe K. Topical corticosteroids: mechanisms of action. Acta Derm Venereol Suppl (Stockh). 1989; 151:7–10.

20. Davidson FF, Dennis EA, Powell M, Glenney JR Jr. Inhibition of phospholipase A2 by "lipocortins" and calpactins. An effect of binding to substrate phospholipids. J Biol Chem. 1987; 262:1698–1705.

21. Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids: new mechanisms for old drugs. N Engl J Med. 2005; 353:1711–1723.

22. Uva L, Miguel D, Pinheiro C, Antunes J, Cruz D, Ferreira J, et al. Mechanisms of action of topical corticosteroids in psoriasis. Int J Endocrinol. 2012; 2012:561018.

23. Ference JD, Last AR. Choosing topical corticosteroids. Am Fam Physician. 2009; 79:135–140.