Real-world outcomes of topical corticosteroids for pediatric phimosis: The impact of lichen sclerosus and second-line clobetasol.

OBJECTIVE

Topical corticosteroids are widely used as first-line therapy for pediatric phimosis, with high success rates reported in controlled studies. However, outcomes in routine clinical practice may be more variable. We evaluated real-world outcomes of topical corticosteroid therapy for pediatric phimosis and explored factors associated with treatment response, including treatment strategy, age, and clinical findings suggestive of Lichen Sclerosus (LS).

MATERIALS AND

METHODS

A prospective observational cohort study was conducted including pediatric patients treated for pathologic phimosis between 2018 and 2023. Patients received a 30-day course of topical corticosteroid therapy with betamethasone as first-line treatment (G1), clobetasol as first-line treatment (G2), or clobetasol as second-line treatment after failure of betamethasone (G3). Treatment response was defined as complete foreskin retractability with adequate hygiene, symptom resolution, and no requirement for surgery after a minimum follow-up of 6 months. Associations between treatment response and treatment strategy, age, and clinical findings compatible with LS were analyzed.

RESULTS

A total of 214 patients were included (mean age 6.7 years; range 1-17 years). Of these, 156 received betamethasone as first-line therapy (G1), 38 received clobetasol as first-line therapy (G2), and 20 received clobetasol as second-line therapy (G3). Response rates were 33.3% in G1, 36.8% in G2, and 60.0% in G3. Clinical findings suggestive of LS were present in 18 patients at presentation; none demonstrated definitive treatment response, 16 ultimately required surgery, and 2 remained under follow-up at the time of analysis. Age was not significantly associated with treatment response. Histopathological findings, available only in surgically treated patients, frequently demonstrated lichenoid changes or definite BXO/LS.

CONCLUSION

In this real-world cohort, response rates to topical corticosteroid therapy were lower than those reported in controlled studies. Clinical findings suggestive of LS were strongly associated with poorer outcomes. In selected patients who failed initial betamethasone therapy, escalation to clobetasol may provide additional benefit before surgery, although this finding should be interpreted cautiously given the observational study design.