Comparison of the Effect of Steroids on the Treatment of Phimosis according to the Steroid Potencies
23 February 2021
Purpose: This study aimed to evaluate the outcomes of topical steroid therapy according to potency as the first-line treatment for boys with symptomatic phimosis.
Materials and Methods: From April 2017 to March 2019, we retrospectively reviewed 45 boys with severe phimosis (Kikiros retractability grade 4 or 5) who presented with phimosis-related complications. During the first year of the study period, methylprednisolone aceponate (MPA, Advantan®, potent topical steroid) was administered in 24 boys. Hydrocortisone butyrate (HCB, Bandel®, moderately potent topical steroid) was administered in 21 boys in the subsequent period. Topical steroids were administered for 4–8 weeks in all patients. Success of the therapy was determined by two conditions at 3 months after therapy: achieving Kikiros grade 3 and less with disappearance of symptoms.
Results: Of 45 boys, 35 (77.8%) achieved success of the therapy. Mean age was 46.64±22.42 months. Recurrence of phimosis with clinical complications was confirmed in three of 35 patients with initial success (8.6%) during the follow-up period. All boys with recurrence showed remission after additional topical steroid therapy. Success rate of the MPA group was higher than that of the HCB group (91.7% and 61.9% respectively, P = .029). Side effects associated with the topical steroid application were not observed in all children.
Conclusion: Topical steroid application is an effective and safe procedure as first-line treatment in symptomatic boys with severe phimosis. Moreover, the potency of topical steroids for the treatment of phimosis is considered a factor affecting the success rate.
- phimosis; steroid; potency
How to Cite
2. Shankar KR, Rickwood AM. The incidence of phimosis in boys. BJU Int. 1999;84:101-2.
3. Oster J. Further fate of the foreskin. Incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys. Arch Dis Child. 1968;43:200-3.
4. Dewan PA, Tieu HC, Chieng BS. Phimosis: Is circumcision necessary? Journal of Paediatrics and Child Health. 1996;32:285-9.
5. Chamberlin JD, Dorgalli C, Abdelhalim A, et al. Randomized open-label trial comparing topical prescription triamcinolone to over-the-counter hydrocortisone for the treatment of phimosis. J Pediatr Urol. 2019;15:388 e1- e5.
6. Moreno G, Corbalan J, Penaloza B, Pantoja T. Topical corticosteroids for treating phimosis in boys. Cochrane Database Syst Rev. 2014CD008973.
7. Ghysel C, Vander Eeckt K, Bogaert GA. Long-term efficiency of skin stretching and a topical corticoid cream application for unretractable foreskin and phimosis in prepubertal boys. Urol Int. 2009;82:81-8.
8. Zampieri N, Corroppolo M, Camoglio FS, Giacomello L, Ottolenghi A. Phimosis: Stretching methods with or without application of topical steroids? Journal of Pediatrics. 2005;147:705-6.
9. Kikiros CS, Beasley SW, Woodward AA. The Response of Phimosis to Local Steroid Application. Pediatric Surgery International. 1993;8:329-32.
10. Esposito C, Centonze A, Alicchio F, Savanelli A, Settimi A. Topical steroid application versus circumcision in pediatric patients with phimosis: a prospective randomized placebo controlled clinical trial. World J Urol. 2008;26:187-90.
11. Torrelo A. Methylprednisolone aceponate for atopic dermatitis. Int J Dermatol. 2017;56:691-7.
12. Luger TA. Balancing efficacy and safety in the management of atopic dermatitis: the role of methylprednisolone aceponate. J Eur Acad Dermatol Venereol. 2011;25:251-8.
13. Favorito LA, Gallo CBM, Costa WS, Sampaio FJB. Ultrastructural Analysis of the Foreskin in Patients With True Phimosis Treated or Not Treated With Topical Betamethasone and Hyaluronidase Ointment. Urology. 2016;98:138-43.
14. Letendre J, Barrieras D, Franc-Guimond J, Abdo A, Houle AM. Topical triamcinolone for persistent phimosis. J Urol. 2009;182:1759-63.
15. Pileggi Fde O, Vicente YA. Phimotic ring topical corticoid cream (0.1% mometasone furoate) treatment in children. J Pediatr Surg. 2007;42:1749-52.
16. Lee JW, Cho SJ, Park EA, Lee SJ. Topical hydrocortisone and physiotherapy for nonretractile physiologic phimosis in infants. Pediatr Nephrol. 2006;21:1127-30.
17. Sookpotarom P, Asawutmangkul C, Srinithiwat B, Leethochawalit S, Vejchapipat P. Is half strength of 0.05 % betamethasone valerate cream still effective in the treatment of phimosis in young children? Pediatric Surgery International. 2013;29:393-6.
18. Hammarstrom S, Hamberg M, Duell EA, Stawiski MA, Anderson TF, Voorhees JJ. Glucocorticoid in inflammatory proliferative skin disease reduces arachidonic and hydroxyeicosatetraenoic acids. Science. 1977;197:994-6.
19. Nuutinen P, Riekki R, Parikka M, et al. Modulation of collagen synthesis and mRNA by continuous and intermittent use of topical hydrocortisone in human skin. British Journal of Dermatology. 2003;148:39-45.
- Abstract Viewed: 0 times
- Just Accepted/6574 Downloaded: 0 times