Male genital lichen sclerosus

Male genital lichen sclerosus (MGLSc) is a chronic inflammatory dermatosis that may lead to phimosis, urethral disease, sexual dysfunction and penile squamous cell carcinoma (PeSCC). Although its aetiology remains incompletely understood, clinical and epidemiological observations increasingly support a central role for chronic occluded exposure of susceptible epithelium to urine. The distribution of lesions to occluded, urine-exposed sites, the high rate of remission after circumcision, the rarity of disease in neonatally circumcised populations, the association with microincontinence and urological procedures, and the occurrence of lesions at urinary stoma sites all suggest an irritative pathogenesis. Secondary inflammatory, fibrotic and epithelial repair processes appear to arise downstream of this primary insult. Clinically, MGLSc presents with pallor, erythema, fissuring and progressive scarring, often accompanied by subtle urethral abnormalities contributing to post-micturition dribbling. Long-standing disease may result in meatal stenosis, urethral strictures and functional impairment. A well-recognised association exists between MGLSc, differentiated penile intraepithelial neoplasia and PeSCC, representing a carcinogenic pathway that is typically independent of human papillomavirus infection and ultraviolet radiation. Management aims to control inflammation, restore the epithelial barrier and reduce occlusion. Potent topical corticosteroids remain first-line therapy, while circumcision is highly effective when topical therapy fails. Additional medical and surgical treatments may be required in refractory or complicated disease. This review summarizes current knowledge on the clinical features, pathophysiology, malignant potential and management of MGLSc, with emphasis on mechanisms related to occlusion and urinary exposure.